Provider Demographics
NPI:1568550408
Name:WOLF, TODD A (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-1855
Practice Address - Fax:682-885-7499
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM06102080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L42VOtherBCBSTX GRP PIN
TX10017863OtherAMERIGROUP PIN
TX137345805Medicaid
TX2013467OtherCIGNA PIN
TX8H8786OtherBCBSTX IND PIN
TX170699603Medicaid
TX137283103Medicaid
TX170699604OtherMEDICAID CSHCN
TX9373506OtherPHCS PIN
TX2490774OtherUHC PIN
TX5607980OtherCCN PIN
TX5607980OtherFIRSTHEALTH PIN
TX170699601Medicaid
TX130406OtherSUPERIOR PIN
1669442042OtherGRP NPI NUMBER
TX7484587OtherAETNA PIN
1669442042OtherGRP NPI NUMBER
TX7484587OtherAETNA PIN
I24347Medicare UPIN
TX137283103Medicaid