Provider Demographics
NPI:1659341964
Name:WOOLF, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:WOOLF
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 31447
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85275-1447
Mailing Address - Country:US
Mailing Address - Phone:480-969-1000
Mailing Address - Fax:480-644-0869
Practice Address - Street 1:2855 E BROWN RD
Practice Address - Street 2:SUITE #10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-4213
Practice Address - Country:US
Practice Address - Phone:480-969-1000
Practice Address - Fax:480-644-0869
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12396207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0029640OtherBLUE CROSS BLUE SHIELD AZ
AZ220157OtherHEALTH NET
AZ0800063OtherUNITED HEALTH CARE
AZ204199Medicaid
AZAZ0029640OtherBLUE CROSS BLUE SHIELD AZ
AZ204199Medicaid