Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 357 | NC |
N | 222Z00000X | Podiatrist | 357 | NC |
Y | 213EP1101X | Primary Podiatric Medicine | 357 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 357 | NC |
N | 213ES0131X | Foot Surgery | 357 | NC |
NPI | 1487712824 |
---|---|
Provider Name | Dr. Kevin Jay Wolf |
First Address | Goldsboro, NC 27530 |
Second Address | Goldsboro, NC 27530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 12/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0818H | BCBS (01) | NC |
890818H | (05) | NC |
T30700 | (02) |