Healthcare Provider Details

I. General information

NPI: 1255390233
Provider Name (Legal Business Name): SANFORD MAYER WOLFE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL STE 230
DAYTON OH
45417-3445
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B3
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-4900
  • Fax: 937-223-4420
Mailing address:
  • Phone: 937-991-3188
  • Fax: 991-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOH34002602
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: