Provider Demographics
NPI:1467647818
Name:MITCH WOLFE, M.D., P.A.
Entity Type:Organization
Organization Name:MITCH WOLFE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-538-5054
Mailing Address - Street 1:1110 W OMEGA ST
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-3205
Mailing Address - Country:US
Mailing Address - Phone:940-538-5054
Mailing Address - Fax:940-538-0028
Practice Address - Street 1:1110 W OMEGA ST
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-3205
Practice Address - Country:US
Practice Address - Phone:940-538-5054
Practice Address - Fax:940-538-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty