Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | M-12944 | ID |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M-12944 | ID |
NPI | 1245483031 |
---|---|
Provider Name | Dr. Jonathon Curtis Wolf |
First Address | Nampa, ID 83686-6011 |
Second Address | Meridian, ID 83642-7552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2008 |
Last Update Date | 26/07/2021 |