Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | N7190 | TX |
Y | 2080P0210X | Pediatric Nephrologist | N7190 | TX |
NPI | 1407059090 |
---|---|
Provider Name | Dr. Matthias Tilmann Florian Wolf |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2007 |
Last Update Date | 07/05/2012 |