Provider Demographics
NPI:1700832375
Name:EUGENE M. WOLF M.D. INC.
Entity Type:Organization
Organization Name:EUGENE M. WOLF M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-276-7759
Mailing Address - Street 1:3000 CALIFORNIA ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2411
Mailing Address - Country:US
Mailing Address - Phone:415-563-2600
Mailing Address - Fax:415-441-5096
Practice Address - Street 1:3000 CALIFORNIA ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2411
Practice Address - Country:US
Practice Address - Phone:415-563-2600
Practice Address - Fax:415-441-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA27308207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A339450Medicaid
CAZZZ64028ZOtherBLUE SHIELD PROVIDER #
CAA27308Medicare UPIN
CAZZZ31698ZMedicare PIN
CAH24700Medicare UPIN
CAZZZ64028ZOtherBLUE SHIELD PROVIDER #