Provider Demographics
NPI:1922446707
Name:WOESSNER, JAMES WARD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WARD
Last Name:WOESSNER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 OLD HALEAKALA HWY
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8505
Mailing Address - Country:US
Mailing Address - Phone:808-250-1128
Mailing Address - Fax:
Practice Address - Street 1:3240 OLD HALEAKALA HWY
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8505
Practice Address - Country:US
Practice Address - Phone:808-250-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI124672081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000N73D6Medicaid
TXN37DMedicare PIN