Provider Demographics
NPI:1740489780
Name:WINGFIELD, JOHN HOUSTON (LAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HOUSTON
Last Name:WINGFIELD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2322
Mailing Address - Country:US
Mailing Address - Phone:716-688-0500
Mailing Address - Fax:716-688-5565
Practice Address - Street 1:835 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2322
Practice Address - Country:US
Practice Address - Phone:716-688-0500
Practice Address - Fax:716-688-5565
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003517-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist