Provider Demographics
NPI:1215990635
Name:WOLF, STEVEN LAURENCE (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LAURENCE
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-521-7777
Mailing Address - Fax:707-573-5426
Practice Address - Street 1:3883 AIRWAY DR STE 202
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1671
Practice Address - Country:US
Practice Address - Phone:707-521-7777
Practice Address - Fax:707-573-5426
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA76717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A767170Medicaid
CAA76717OtherSTATE MEDICAL LICENSE
CABW7488578OtherFEDERAL DEA LICENSE