Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | R0159 | TX |
NPI | 1023100492 |
---|---|
Provider Name | J Stuart Wolf JR. |
First Address | Austin, TX 78712 |
Second Address | Austin, TX 78712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 03/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
369729401 | (05) | TX |
F92842 | (02) | MI |