MEDICARE: DR. JILL ELLEN WOLF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	J7393	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J7393	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1093792418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL ELLEN WOLF MD

Provider Business Mailing Address
First Line	:	730 E ELDORADO PKWY
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5444
Country	:	US
Telephone Number	:	972-292-3330
Fax Number	:	972-292-3330

Provider Business Practice Location Address
First Line	:	730 E ELDORADO PKWY
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5444
Country	:	US
Telephone Number	:	972-292-3330
Fax Number	:	972-292-3330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	03/07/2023

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