Provider Demographics
NPI:1912920729
Name:WOLFSON, GARY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 7500
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-833-1010
Mailing Address - Fax:561-833-0952
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 7500
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-833-1010
Practice Address - Fax:561-833-0952
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME057852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE84314Medicare UPIN
FL12205Medicare ID - Type Unspecified