Healthcare Provider Details

I. General information

NPI: 1063349025
Provider Name (Legal Business Name): CHARLES WOLF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 E RANCH CIR
DRAPER UT
84020-9013
US

IV. Provider business mailing address

942 E RANCH CIR
DRAPER UT
84020-9013
US

V. Phone/Fax

Practice location:
  • Phone: 801-502-7030
  • Fax:
Mailing address:
  • Phone: 801-502-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number2026002559
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: