Healthcare Provider Details

I. General information

NPI: 1124230958
Provider Name (Legal Business Name): DANIEL WOLFSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON ROAD SUITE #810
MIAMI BEACH FL
33140-3110
US

IV. Provider business mailing address

4300 ALTON RD #810
MIAMI BEACH FL
33140-2800
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-5925
  • Fax: 305-674-5927
Mailing address:
  • Phone: 305-674-5925
  • Fax: 305-674-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME0098505
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: