Provider Demographics
NPI:1578121935
Name:WOLFF, RAYMOND SHAUN
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:SHAUN
Last Name:WOLFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6936 SHEA DR APT A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80902-7334
Mailing Address - Country:US
Mailing Address - Phone:503-504-4420
Mailing Address - Fax:
Practice Address - Street 1:6936 SHEA DR APT A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80902-7334
Practice Address - Country:US
Practice Address - Phone:503-504-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant