Provider Demographics
NPI:1215980115
Name:WOLF, SHERRY LYNN C (MD)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LYNN C
Last Name:WOLF
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERRY
Other - Middle Name:LYNN C
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 GARLAND JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-4097
Mailing Address - Country:US
Mailing Address - Phone:940-552-9991
Mailing Address - Fax:940-553-1358
Practice Address - Street 1:1000 GARLAND JOHNSTON DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4097
Practice Address - Country:US
Practice Address - Phone:940-552-9991
Practice Address - Fax:940-553-1358
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3303207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372988ZNXTMedicare PIN
TX8D2719Medicare PIN
TXE28263Medicare UPIN