Provider Demographics
NPI:1649369935
Name:WOLF, RONALD FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FRANK
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-1877
Practice Address - Fax:562-933-1866
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD19406208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8186942Medicaid
OR074307Medicaid
G05258Medicare UPIN
OR074307Medicaid