Healthcare Provider Details

I. General information

NPI: 1295773984
Provider Name (Legal Business Name): BRUCE L WOLF MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING PIKE STE 307
NASHVILLE TN
37205-2013
US

IV. Provider business mailing address

4230 HARDING PIKE STE 307
NASHVILLE TN
37205-2013
US

V. Phone/Fax

Practice location:
  • Phone: 615-292-8288
  • Fax: 615-896-4108
Mailing address:
  • Phone: 615-292-8288
  • Fax: 615-896-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE L WOLF
Title or Position: MDOWNER
Credential: MD
Phone: 615-292-8299