MEDICARE: DR. DOUGLAS DEAN WOLFE DO

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	207Q00000X	Family Medicine Physician	1043	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000425042	OTHER	WV	BLUE CROSS
3	P01447173	OTHER	WV	RAILROAD

General Provider Information

NPI Number	:	1316907165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS DEAN WOLFE DO

Provider Business Mailing Address
First Line	:	800 E MAIN ST
Second Line	:	SUITE B
City	:	MANNINGTON
State	:	WV
Zip	:	26582-1215
Country	:	US
Telephone Number	:	304-986-2996
Fax Number	:	304-986-2998

Provider Business Practice Location Address
First Line	:	800 E MAIN ST
Second Line	:	SUITE B
City	:	MANNINGTON
State	:	WV
Zip	:	26582-1215
Country	:	US
Telephone Number	:	304-986-2996
Fax Number	:	304-986-2998

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/28/2016

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