Provider Demographics
NPI:1295773984
Name:BRUCE L WOLF MD
Entity type:Organization
Organization Name:BRUCE L WOLF MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDOWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-292-8299
Mailing Address - Street 1:4230 HARDING PIKE
Mailing Address - Street 2:STE 307
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2013
Mailing Address - Country:US
Mailing Address - Phone:615-292-8288
Mailing Address - Fax:615-896-4108
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:STE 307
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-292-8288
Practice Address - Fax:615-896-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3713123Medicare ID - Type Unspecified