Provider Demographics
NPI:1881673820
Name:WOLACH, JAMES WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:WOLACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5890 W 13TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4816
Mailing Address - Country:US
Mailing Address - Phone:970-378-1000
Mailing Address - Fax:970-378-1899
Practice Address - Street 1:5890 W 13TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4816
Practice Address - Country:US
Practice Address - Phone:970-378-1000
Practice Address - Fax:970-378-1899
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO34548208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01345487Medicaid
COF24121Medicare UPIN
CO01345487Medicaid
COCOA100680Medicare PIN