Provider Demographics
NPI:1417902164
Name:WOLFORD, DALE EDWIN (DO)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:EDWIN
Last Name:WOLFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:1110 E GIBSON ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-5011
Practice Address - Country:US
Practice Address - Phone:863-494-1918
Practice Address - Fax:863-993-2116
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0063736207V00000X
FLOS4624207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1966OtherWEST VA MEDICAL LICENSE
WV1966OtherWEST VA MEDICAL LICENSE
WV1966OtherWEST VA MEDICAL LICENSE