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General NPI Number Information
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NPI Number | 1497974190
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Entity Type | Organization
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Legal Business Name | WOLF PODIATRY CORP
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 12630 MONTE VISTA RD STE 101
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City | POWAY
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State | CA
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Zip | 92064-2526
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Country | US
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Telephone | 858-451-2151
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Fax | 858-451-3097
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Provider Business Mailing Address
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Address Line | 12630 MONTE VISTA RD STE 101
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City | POWAY
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State | CA
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Zip | 92064-2526
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Country | US
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Telephone | 858-451-2151
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Fax | 858-451-3097
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CLIFFORD J WOLF
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Credential | DPM
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Telephone | 858-451-2151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | E2161
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License Number State | CA
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