Provider Demographics
NPI:1063584357
Name:BRIAN D WOLFF MD PA
Entity type:Organization
Organization Name:BRIAN D WOLFF MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-643-4030
Mailing Address - Street 1:671 GOODLETTE RD N
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5469
Mailing Address - Country:US
Mailing Address - Phone:239-643-4030
Mailing Address - Fax:239-643-6010
Practice Address - Street 1:671 GOODLETTE RD N
Practice Address - Street 2:SUITE 120
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5469
Practice Address - Country:US
Practice Address - Phone:239-643-4030
Practice Address - Fax:239-643-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61719207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17829Medicare ID - Type Unspecified