Provider Demographics
NPI:1154300192
Name:WOLFE, PERRY TALBOTT II (M D)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:TALBOTT
Last Name:WOLFE
Suffix:II
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N OREGON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4042
Mailing Address - Country:US
Mailing Address - Phone:915-532-1021
Mailing Address - Fax:915-545-2312
Practice Address - Street 1:1515 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4042
Practice Address - Country:US
Practice Address - Phone:915-532-1021
Practice Address - Fax:915-545-2312
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE81497Medicare UPIN