Provider Demographics
NPI:1710075411
Name:WOLFE, PHILLIP A (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 W LAS POSITAS BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5801
Mailing Address - Country:US
Mailing Address - Phone:925-460-8167
Mailing Address - Fax:
Practice Address - Street 1:5575 W LAS POSITAS BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5801
Practice Address - Country:US
Practice Address - Phone:925-460-8167
Practice Address - Fax:925-460-0913
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG83272207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G832720Medicaid
CAG83272OtherSTATE LICENSE
CABW4968179OtherDEA
CA00G832720Medicare ID - Type Unspecified
CA00G832720Medicaid