Provider Demographics
NPI:1770973166
Name:WOHLFEIL, JEFFERY ROBERT (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ROBERT
Last Name:WOHLFEIL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 N COURT AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1515
Mailing Address - Country:US
Mailing Address - Phone:231-935-5800
Mailing Address - Fax:
Practice Address - Street 1:271 MCCOY RD W
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8253
Practice Address - Country:US
Practice Address - Phone:989-732-3529
Practice Address - Fax:989-732-7865
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007284363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant