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NPI Code Detail

MEDICARE: DR. KIRK DANA WOLFE M.D.

MEDICARE: DR. KIRK DANA WOLFE M.D.
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
12084P0804XChild & Adolescent Psychiatry Physician18215OR

General Provider Information

NPI Number : 1487781993
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIRK DANA WOLFE M.D.
Provider Business Mailing Address
First Line : 29 AQUINAS ST
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-1203
Country : US
Telephone Number : 503-635-9342
Fax Number : 503-232-0138
Provider Business Practice Location Address
First Line : 1500 NE IRVING ST STE 250
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2265
Country : US
Telephone Number : 503-233-4356
Fax Number : 503-232-0138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2007
Last Update Date : 07/08/2007

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