Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301092890 | MI |
NPI | 1013173822 |
---|---|
Provider Name | Dr. Thomas Reagan Wolf |
First Address | Rincon, GA 31326-9416 |
Second Address | Rincon, GA 31326-9416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 09/08/2019 |