Healthcare Provider Details

I. General information

NPI: 1235183682
Provider Name (Legal Business Name): JEFFERY LAWRENCE WOLFF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 BOX 1791
APO AE
09180
DE

IV. Provider business mailing address

CMR 402 BOX 1791
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 0496383927597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberK0402
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: