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General NPI Number Information
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NPI Number | 1851354567
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Entity Type | Individual
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Provider Name | CLINTON GROVER WOLBOLDT MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 7601 QUAKER AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-3360
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Country | US
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Telephone | 806-725-9603
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Fax | 806-725-9500
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Provider Business Mailing Address
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Address Line | 3420 22ND PL
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City | LUBBOCK
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State | TX
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Zip | 79410-1314
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Country | US
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Telephone | 806-725-5844
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Fax | 806-723-6532
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | K4298
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License Number State | TX
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