Provider Demographics
NPI:1801448600
Name:WOLFE, DANIEL L
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FARRIS DR
Mailing Address - Street 2:
Mailing Address - City:EARLSBORO
Mailing Address - State:OK
Mailing Address - Zip Code:74840-9501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 FARRIS DR
Practice Address - Street 2:
Practice Address - City:EARLSBORO
Practice Address - State:OK
Practice Address - Zip Code:74840-9501
Practice Address - Country:US
Practice Address - Phone:405-388-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist