Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 01052930A | IN |
Y | 207L00000X | Anesthesiologist | 18225 | MS |
N | 207L00000X | Anesthesiologist | 42241 | CO |
N | 207L00000X | Anesthesiologist | A86812 | CA |
NPI | 1003868449 |
---|---|
Provider Name | Dr. Lee Tan Wolfe |
First Address | Monument, CO 80132-2852 |
Second Address | Colorado Springs, CO 80907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 10/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05156585 | (05) | MS |
9853209153 | (02) |