Provider Demographics
NPI:1356392062
Name:JAMES D WOLFF MD PC
Entity type:Organization
Organization Name:JAMES D WOLFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-955-6767
Mailing Address - Street 1:2700 1ST AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4306
Mailing Address - Country:US
Mailing Address - Phone:515-955-6767
Mailing Address - Fax:515-576-8581
Practice Address - Street 1:2700 1ST AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4306
Practice Address - Country:US
Practice Address - Phone:515-955-6767
Practice Address - Fax:515-576-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33193207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0417584Medicaid
IA12977OtherMIDLANDS
IAP00041351OtherRAILROAD MEDICARE
IA35350OtherWELLMARK
IA0417584Medicaid