Provider Demographics
NPI:1952569030
Name:WOLFSON, JAMES KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNETH
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1900 W SUNSHINE ST
Mailing Address - Street 2:US MEDICAL CENTER FOR FEDERAL PRISONERS
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2240
Mailing Address - Country:US
Mailing Address - Phone:417-862-7041
Mailing Address - Fax:417-874-1633
Practice Address - Street 1:1900 W SUNSHINE ST
Practice Address - Street 2:US MEDICAL CENTER FOR FEDERAL PRISONERS
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2240
Practice Address - Country:US
Practice Address - Phone:417-862-7041
Practice Address - Fax:417-874-1633
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR6N422084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
107555Medicare PIN
E98212Medicare UPIN