Provider Demographics
NPI:1063471191
Name:WOLFE, GILBERT WALLACE (CRNA)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:WALLACE
Last Name:WOLFE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13633 BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1903
Mailing Address - Country:US
Mailing Address - Phone:210-595-3923
Mailing Address - Fax:210-595-3923
Practice Address - Street 1:13633 BLUFFCIRCLE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-1903
Practice Address - Country:US
Practice Address - Phone:210-595-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX439257367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered