MEDICARE: DR. AMANDA J WOLTHOFF 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	539959	TX
2	207N00000X	Dermatology Physician	539959	TX

General Provider Information

NPI Number	:	1992016869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA J WOLTHOFF M.D.

Provider Business Mailing Address
First Line	:	6200 LYNDON B JOHNSON FWY STE 110
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6305
Country	:	US
Telephone Number	:	817-985-7685
Fax Number	:	833-337-6329

Provider Business Practice Location Address
First Line	:	6200 LYNDON B JOHNSON FWY STE 110
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6305
Country	:	US
Telephone Number	:	817-846-8502
Fax Number	:

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

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	11/19/2023

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