Provider Demographics
NPI:1811084171
Name:WOLFSON, ERIC H (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:H
Last Name:WOLFSON
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:PO BOX 17708
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-7708
Mailing Address - Country:US
Mailing Address - Phone:228-865-3201
Mailing Address - Fax:228-575-1464
Practice Address - Street 1:1340 BROAD STREET
Practice Address - Street 2:SUITE 440
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-865-3201
Practice Address - Fax:228-575-1464
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18381207T00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07878395Medicaid
MSP00222453OtherRAILROAD MEDICARE
MSP00222453OtherRAILROAD MEDICARE
MSF97881Medicare UPIN