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General NPI Number Information
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NPI Number | 1619101284
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Entity Type | Organization
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Legal Business Name | MITCH C WOLFE MD PA
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 310 W SOUTH ST #101
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City | HENRIETTA
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State | TX
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Zip | 76365-3346
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Country | US
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Telephone | 940-538-5054
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Fax | 940-538-0028
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Provider Business Mailing Address
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Address Line | PO BOX 180
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City | HENRIETTA
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State | TX
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Zip | 76365-0180
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Country | US
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Telephone | 940-538-5054
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Fax | 940-538-0028
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MITCH C WOLFE
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Credential | M.D.
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Telephone | 940-538-5054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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