Healthcare Provider Details

I. General information

NPI: 1649298803
Provider Name (Legal Business Name): DAVID RUSSELL WOLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8890 N UNION BLVD SUITE 170
COLORADO SPRINGS CO
80920-7799
US

IV. Provider business mailing address

2518 MARSTON HTS
COLORADO SPRINGS CO
80920-5131
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6422
  • Fax:
Mailing address:
  • Phone: 719-592-0747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20680
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: