Provider Demographics
NPI:1366474181
Name:WOLF, BERNARD ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:ARTHUR
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2415 HIGH SCHOOL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1815
Mailing Address - Country:US
Mailing Address - Phone:925-685-8894
Mailing Address - Fax:925-609-7558
Practice Address - Street 1:2415 HIGH SCHOOL AVE STE 300
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1815
Practice Address - Country:US
Practice Address - Phone:925-685-8894
Practice Address - Fax:925-609-7558
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA29305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25710Medicare UPIN