Provider Demographics
NPI:1659339562
Name:WOLFER, GEORGE K JR (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:K
Last Name:WOLFER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4366
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-4366
Mailing Address - Country:US
Mailing Address - Phone:812-332-8242
Mailing Address - Fax:812-333-7684
Practice Address - Street 1:2651 E DISCOVERY PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-9059
Practice Address - Country:US
Practice Address - Phone:812-353-5252
Practice Address - Fax:812-353-5792
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041354A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300072210OtherRR MEDICARE
INP00114571OtherRAILROAD MEDICARE
IN100344040Medicaid
E78692Medicare UPIN
IN100344040Medicaid
IN542650PMedicare PIN
IN300072210OtherRR MEDICARE