Provider Demographics
NPI:1649451626
Name:PAUL MITCHELL WOLF, MD, PA
Entity type:Organization
Organization Name:PAUL MITCHELL WOLF, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-837-2222
Mailing Address - Street 1:12414 ALDERBROOK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2482
Mailing Address - Country:US
Mailing Address - Phone:512-837-2222
Mailing Address - Fax:512-837-2223
Practice Address - Street 1:12414 ALDERBROOK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2482
Practice Address - Country:US
Practice Address - Phone:512-837-2222
Practice Address - Fax:512-837-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y384Medicare PIN