Provider Demographics
NPI:1669449237
Name:WOLF, MARK ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7720 S BROADWAY
Mailing Address - Street 2:STE 250
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:303-347-8786
Mailing Address - Fax:303-347-1087
Practice Address - Street 1:7720 S BROADWAY
Practice Address - Street 2:STE 250
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122
Practice Address - Country:US
Practice Address - Phone:303-347-8786
Practice Address - Fax:303-347-1087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO18712207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01187129Medicaid
CO01187129Medicaid
COC97801Medicare ID - Type Unspecified