MEDICARE: GILBERT WALLACE WOLFE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	439257	TX

General Provider Information

NPI Number	:	1063471191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILBERT WALLACE WOLFE CRNA

Provider Business Mailing Address
First Line	:	13633 BLUFF CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-1903
Country	:	US
Telephone Number	:	210-595-3923
Fax Number	:	210-595-3923

Provider Business Practice Location Address
First Line	:	13633 BLUFFCIRCLE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-1903
Country	:	US
Telephone Number	:	210-595-3923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	07/08/2007

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