Provider Demographics
NPI:1689791782
Name:WOLF, BRYAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JAMES
Last Name:WOLF
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 1:6165 RIDGEVIEW CT
Mailing Address - Street 2:STE C
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-6332
Mailing Address - Country:US
Mailing Address - Phone:775-287-4379
Mailing Address - Fax:
Practice Address - Street 1:6165 RIDGEVIEW CT
Practice Address - Street 2:STE C
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-6332
Practice Address - Country:US
Practice Address - Phone:775-824-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12399207RR0500X
NMMD2011-0746207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology