Healthcare Provider Details

I. General information

NPI: 1063451805
Provider Name (Legal Business Name): DANIEL EUGENE WOLF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6537 35TH AVE SW
SEATTLE WA
98126-3005
US

IV. Provider business mailing address

6537 35TH AVE SW
SEATTLE WA
98126-3005
US

V. Phone/Fax

Practice location:
  • Phone: 206-932-9292
  • Fax: 206-932-9797
Mailing address:
  • Phone: 206-932-9292
  • Fax: 206-932-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberOP00001163
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: