Healthcare Provider Details

I. General information

NPI: 1467647818
Provider Name (Legal Business Name): MITCH WOLFE, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W OMEGA ST
HENRIETTA TX
76365-3205
US

IV. Provider business mailing address

1110 W OMEGA ST
HENRIETTA TX
76365-3205
US

V. Phone/Fax

Practice location:
  • Phone: 940-538-5054
  • Fax: 940-538-0028
Mailing address:
  • Phone: 940-538-5054
  • Fax: 940-538-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL0708
License Number StateTX

VIII. Authorized Official

Name: DR. MITCH C WOLFE
Title or Position: PROVIDER/PRESIDENT
Credential: M.D.
Phone: 940-538-5054