Provider Demographics
NPI:1164732442
Name:WOLF, ESZTER DEMETER (MD)
Entity Type:Individual
Prefix:MRS
First Name:ESZTER
Middle Name:DEMETER
Last Name:WOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ESZTER
Other - Middle Name:
Other - Last Name:DEMETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10063 N BLUE CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-5213
Mailing Address - Country:US
Mailing Address - Phone:520-820-0973
Mailing Address - Fax:
Practice Address - Street 1:10063 N BLUE CROSSING WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-5213
Practice Address - Country:US
Practice Address - Phone:520-820-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR721822085R0202X
AZ457622085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005472OtherGROUP MEDICAID ID
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZZWCBBMOtherGROUP MEDICARE ID
AZ921495OtherPHYSICIAN AHCCCS ID
AZ1841261989OtherGROUP NPI