Provider Demographics
NPI:1740250489
Name:WOLFE, IRVING LARRY (DO)
Entity type:Individual
Prefix:
First Name:IRVING
Middle Name:LARRY
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 50TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5920
Mailing Address - Country:US
Mailing Address - Phone:515-255-7414
Mailing Address - Fax:515-274-6913
Practice Address - Street 1:2600 GRAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5300
Practice Address - Country:US
Practice Address - Phone:515-255-7414
Practice Address - Fax:515-274-6913
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA022572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0297846Medicaid
IA1063545390OtherBCBS
IA58424Medicare PIN
A03598Medicare UPIN