Provider Demographics
NPI:1730140955
Name:WOLFSON, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:A-100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:1951 N WILMOT RD
Practice Address - Street 2:BUILDING 3
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-8000
Practice Address - Country:US
Practice Address - Phone:520-327-9573
Practice Address - Fax:520-327-0391
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-02-14
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Provider Licenses
StateLicense IDTaxonomies
AZ16662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ1139898OtherPTAN
AZD37867Medicare UPIN