=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104890318
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYRIL WOLF MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2006
-----------------------------------------------------
Last Update Date | 12/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 FROSTWOOD STE 290
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-876-3847
-----------------------------------------------------
Fax | 713-467-7421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 FROSTWOOD STE 290
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-876-3847
-----------------------------------------------------
Fax | 713-467-7421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | E9028
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | C40883
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------