Provider Demographics
NPI:1710983184
Name:WOLFE, PAUL L (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 S 48TH ST
Mailing Address - Street 2:STE 412
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1225
Mailing Address - Country:US
Mailing Address - Phone:402-489-4600
Mailing Address - Fax:402-489-5151
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:STE 412
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1225
Practice Address - Country:US
Practice Address - Phone:402-489-4600
Practice Address - Fax:402-489-5151
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE18466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078842713Medicaid
D16022Medicare UPIN
269438Medicare ID - Type Unspecified