Provider Demographics
NPI:1043292436
Name:WOLFE, PETER QUINTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:QUINTIN
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WEST LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-663-4892
Mailing Address - Fax:515-663-4899
Practice Address - Street 1:3600 WEST LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-663-4892
Practice Address - Fax:515-663-4899
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2220343Medicaid
IA23565Medicare ID - Type Unspecified
IAA02529Medicare UPIN