Provider Demographics
NPI:1609292457
Name:CARL WOLFER MD
Entity Type:Organization
Organization Name:CARL WOLFER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-241-1455
Mailing Address - Street 1:1555 EAST ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1153
Mailing Address - Country:US
Mailing Address - Phone:530-241-1455
Mailing Address - Fax:530-241-7669
Practice Address - Street 1:1555 EAST ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1153
Practice Address - Country:US
Practice Address - Phone:530-241-1455
Practice Address - Fax:530-241-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20984261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care