MEDICARE: DR. JOHN S WOLF JR. 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
1	207R00000X	Internal Medicine Physician	ME27172	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1749	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1922087568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN S WOLF JR. M.D.

Provider Business Mailing Address
First Line	:	7000 W OAKLAND PARK BLVD
Second Line	:	#202
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1016
Country	:	US
Telephone Number	:	954-253-4467
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 W OAKLAND PARK BLVD
Second Line	:	#202
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1016
Country	:	US
Telephone Number	:	954-253-4467
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	12/03/2012

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