Healthcare Provider Details

I. General information

NPI: 1962755165
Provider Name (Legal Business Name): JASON DANIEL WOLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NW 84TH AVE STE 300
PLANTATION FL
33324-1859
US

IV. Provider business mailing address

11760 SW 40TH ST STE 403
MIAMI FL
33175-3595
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-2929
  • Fax:
Mailing address:
  • Phone: 305-226-2020
  • Fax: 305-226-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number280384
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME117887
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: