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General NPI Number Information
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NPI Number | 1063691301
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Entity Type | Organization
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Legal Business Name | KEVIN JAY WOLF
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 407 N HERMAN ST
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City | GOLDSBORO
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State | NC
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Zip | 27530-3816
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Country | US
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Telephone | 919-583-9788
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Fax | 919-583-9790
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Provider Business Mailing Address
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Address Line | 407 N HERMAN ST
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City | GOLDSBORO
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State | NC
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Zip | 27530-3816
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Country | US
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Telephone | 919-583-9788
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Fax | 919-583-9790
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN JAY WOLF
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Credential | DPM
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Telephone | 919-583-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 357
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License Number State | NC
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