Provider Demographics
NPI:1790853885
Name:WOLFE, WAYNE W (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:W
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:311 MILLER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2897
Mailing Address - Country:US
Mailing Address - Phone:415-380-0480
Mailing Address - Fax:415-380-8788
Practice Address - Street 1:311 MILLER AVE STE B
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2897
Practice Address - Country:US
Practice Address - Phone:415-380-0480
Practice Address - Fax:415-380-8788
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH89139Medicare UPIN
CA00A78480Medicare ID - Type Unspecified