MEDICARE: STEPHEN P 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	17827	OK

General Provider Information

NPI Number	:	1558475756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN P WOLF MD

Provider Business Mailing Address
First Line	:	PO BOX 269090
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9090
Country	:	US
Telephone Number	:	405-231-3857
Fax Number	:	405-942-7743

Provider Business Practice Location Address
First Line	:	6205 N SANTA FE AVE
Second Line	:	SUITE 201
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7537
Country	:	US
Telephone Number	:	405-425-8509
Fax Number	:	405-810-4989

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/23/2008

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