Healthcare Provider Details

I. General information

NPI: 1275551020
Provider Name (Legal Business Name): ANDREW J WOLFE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HERITAGE RD STE 100
GOLDEN CO
80401-3673
US

IV. Provider business mailing address

725 HERITAGE ROAD STE 100
GOLDEN CO
80401-3169
US

V. Phone/Fax

Practice location:
  • Phone: 303-278-2600
  • Fax: 303-278-4841
Mailing address:
  • Phone: 303-278-2600
  • Fax: 303-278-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number39229
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number39229
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: