Provider Demographics
NPI:1740314764
Name:WOLF, JEFFREY A (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:WOLF
Suffix:
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 1:42 PENINSULA CTR
Mailing Address - Street 2:#400
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3506
Mailing Address - Country:US
Mailing Address - Phone:714-226-6567
Mailing Address - Fax:
Practice Address - Street 1:42 PENINSULA CTR
Practice Address - Street 2:#400
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3506
Practice Address - Country:US
Practice Address - Phone:714-226-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25318207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology