Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | DO.2669 | AL |
Y | 207N00000X | Dermatologist | OS15357 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | DO.2669 | AL |
N | 207ND0101X | MOHS-Micrographic Surgeon | OS15357 | FL |
NPI | 1417073503 |
---|---|
Provider Name | Mr. Christopher Michael Wolfe |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Pensacola, FL 32503-2019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 24/09/2021 |