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General NPI Number Information
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NPI Number | 1962755165
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Entity Type | Individual
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Provider Name | JASON DANIEL WOLF M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 11760 SW 40TH ST SUITE 403
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City | MIAMI
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State | FL
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Zip | 33175-3582
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Country | US
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Telephone | 305-226-2020
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Fax | 305-226-2018
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Provider Business Mailing Address
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Address Line | 11760 SW 40TH ST SUITE 403
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City | MIAMI
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State | FL
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Zip | 33175-3582
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Country | US
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Telephone | 305-226-2020
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Fax | 305-226-2018
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 280384
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME117887
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License Number State | FL
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