=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477637783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY MICHAEL WOLFE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 11/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 84 SANTA ROSA ST SUITE A
-----------------------------------------------------
City | SAN LUIS OBISPO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93405-1812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-548-8585
-----------------------------------------------------
Fax | 805-548-8589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 84 SANTA ROSA ST SUITE A
-----------------------------------------------------
City | SAN LUIS OBISPO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93405-1812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-548-8585
-----------------------------------------------------
Fax | 805-548-8589
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | A19347
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------