Provider Demographics
NPI:1376546051
Name:WOLF, DAVID SAMUEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAMUEL
Last Name:WOLF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-2905
Mailing Address - Country:US
Mailing Address - Phone:713-728-3117
Mailing Address - Fax:713-728-2212
Practice Address - Street 1:11515 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-2905
Practice Address - Country:US
Practice Address - Phone:713-728-3117
Practice Address - Fax:713-728-2212
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0359213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2815792006OtherCIGNA - PPO
TX2815792007OtherCIGNA - COM. HMO
TX4269450001OtherMEDICARE DME
TX1026570OtherAETNA #
TX092849101Medicaid
TXTN04OtherBCBS
TX28157OtherCIGNA - HMO
TX10014884OtherAMERIGROUP
TX23006OtherFIRST HEALTH
TX17079691OtherEVERCARE
TX10014884OtherAMERIGROUP
TX17079691OtherEVERCARE
TX23006OtherFIRST HEALTH
TXT16715Medicare UPIN