Provider Demographics
NPI:1831129139
Name:WOLF, PAUL MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MITCHELL
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14365 W STATE HIGHWAY 29
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4309
Mailing Address - Country:US
Mailing Address - Phone:512-778-5160
Mailing Address - Fax:512-778-6847
Practice Address - Street 1:14365 W STATE HIGHWAY 29
Practice Address - Street 2:SUITE 10
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4309
Practice Address - Country:US
Practice Address - Phone:512-778-5160
Practice Address - Fax:512-778-6847
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM0312207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6633Medicare PIN
TXI23728Medicare UPIN