Provider Demographics
NPI:1679536015
Name:WOLFF, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:WOLFF
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 1:19564 C16
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:IA
Mailing Address - Zip Code:51001-8697
Mailing Address - Country:US
Mailing Address - Phone:712-266-3033
Mailing Address - Fax:515-666-8960
Practice Address - Street 1:19564 C16
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:IA
Practice Address - Zip Code:51001-8697
Practice Address - Country:US
Practice Address - Phone:712-266-3033
Practice Address - Fax:515-666-8960
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1695207Q00000X
IA26911207Q00000X, 207QA0401X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42483OtherWELLMARK BCBS IA
SD4994381OtherWELLMARK BCBS SD
IA7761033Medicaid
IA3052779Medicaid
IA3052779Medicaid
IA7761033Medicaid
IAI4223Medicare PIN