Provider Demographics
NPI:1194110072
Name:WOLF, KRISTIN ROSE (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ROSE
Last Name:WOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ROSE
Other - Last Name:BUNATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:508 MEDICAL CENTER BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2954
Mailing Address - Country:US
Mailing Address - Phone:281-573-8333
Mailing Address - Fax:936-703-5323
Practice Address - Street 1:508 MEDICAL CENTER BLVD STE 380
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2954
Practice Address - Country:US
Practice Address - Phone:281-573-8333
Practice Address - Fax:936-703-5323
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7928207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFW7771339OtherDEA