Healthcare Provider Details

I. General information

NPI: 1790845253
Provider Name (Legal Business Name): SCOTT WILLIAM WOLF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SCOTT WILLIAM WOLF MD

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

PO BOX 4069
EVERETT WA
98204-0007
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-3181
  • Fax: 509-227-7070
Mailing address:
  • Phone: 425-407-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0052478
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61089230
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: