Provider Demographics
NPI:1841923125
Name:WOLF, SCOTT G (PROSTHETIST)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:WOLF
Suffix:
Gender:M
Credentials:PROSTHETIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 N FINE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1512
Mailing Address - Country:US
Mailing Address - Phone:559-251-5557
Mailing Address - Fax:559-251-5559
Practice Address - Street 1:2039 N FINE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1512
Practice Address - Country:US
Practice Address - Phone:559-251-5557
Practice Address - Fax:559-251-5559
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier