Provider Demographics
NPI:1245613793
Name:WOLF, LANCE EVERETT (DPM)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:EVERETT
Last Name:WOLF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2010 S LOOP 336 W STE 100
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3313
Mailing Address - Country:US
Mailing Address - Phone:936-756-0800
Mailing Address - Fax:936-756-0812
Practice Address - Street 1:2010 S LOOP 336 W STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-756-0800
Practice Address - Fax:936-756-0812
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2310213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery