Provider Demographics
NPI:1770514523
Name:WOLF, ALAN W (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:W
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1915 E REZANOF DR
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6602
Mailing Address - Country:US
Mailing Address - Phone:907-486-9580
Mailing Address - Fax:907-486-9586
Practice Address - Street 1:1915 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6602
Practice Address - Country:US
Practice Address - Phone:907-486-9580
Practice Address - Fax:907-486-9586
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK3399207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK200033245OtherMEDICARE RAILROAD
AKMD3399Medicaid
AK200033245OtherMEDICARE RAILROAD
AKK150452Medicare Oscar/Certification