Provider Demographics
NPI:1811989858
Name:WOLFE, MITCHELL CURTIS (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:CURTIS
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MITCH
Other - Middle Name:C
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:PO BOX 9261
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-9261
Mailing Address - Country:US
Mailing Address - Phone:940-764-5200
Mailing Address - Fax:940-764-5201
Practice Address - Street 1:4327 BARNETT RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-2303
Practice Address - Country:US
Practice Address - Phone:940-764-5200
Practice Address - Fax:940-764-5201
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-12-29
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXL0708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112012308Medicaid
TX112012308Medicaid
TX8D1445Medicare PIN