Provider Demographics
NPI:1558475756
Name:WOLF, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 269090
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9090
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-942-7743
Practice Address - Street 1:6205 N SANTA FE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7537
Practice Address - Country:US
Practice Address - Phone:405-425-8509
Practice Address - Fax:405-810-4989
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK17827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE89346Medicare UPIN