Provider Demographics
NPI:1356537781
Name:WOLFF, TERRY L (DO)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:WOLFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9072
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58106
Mailing Address - Country:US
Mailing Address - Phone:701-235-4503
Mailing Address - Fax:701-235-4503
Practice Address - Street 1:2700 12TH AVE SW
Practice Address - Street 2:SUITE D
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-235-4503
Practice Address - Fax:701-235-4503
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4256207Q00000X, 2083X0100X
MN25160207Q00000X, 2083X0100X
AZ2076207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine