Provider Demographics
NPI:1245483031
Name:WOLF, JONATHON CURTIS (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:CURTIS
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:875 S VANGUARD WAY STE 200B
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8540
Mailing Address - Country:US
Mailing Address - Phone:208-563-0001
Mailing Address - Fax:208-563-0777
Practice Address - Street 1:875 S VANGUARD WAY STE 200B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8540
Practice Address - Country:US
Practice Address - Phone:208-563-0001
Practice Address - Fax:208-563-0777
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-12944207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery