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NPI Code Detail

MEDICARE: BOBBY JOE WOLFE JR.

MEDICARE: BOBBY JOE WOLFE JR.
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
12083P0901XPublic Health & General Preventive Medicine Physician07076MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740324698
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBBY JOE WOLFE JR.
Provider Business Mailing Address
First Line : 100 TAMBERLINE ST
Second Line :
City : BRANDON
State : MS
Zip : 39042-3164
Country : US
Telephone Number : 601-825-2141
Fax Number :
Provider Business Practice Location Address
First Line : 100 TAMBERLINE ST
Second Line :
City : BRANDON
State : MS
Zip : 39042-3164
Country : US
Telephone Number : 601-825-2141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 04/15/2011

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