Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 158481 | MA |
NPI | 1023190634 |
---|---|
Provider Name | James Scott Wrede |
First Address | North Falmouth, MA 02556-2019 |
Second Address | North Falmouth, MA 02556-2019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158481 | TUFTS (01) | MA |
3196321 | (05) | MA |
68929 | HPHC (01) | MA |
BW6210152 | DEA (01) | |
G96157 | (02) | MA |
J21133 | BCBS (01) | MA |