Provider Demographics
NPI:1316996028
Name:WOLF, JACK H (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:H
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 RIVERBEND RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253
Mailing Address - Country:US
Mailing Address - Phone:336-578-3465
Mailing Address - Fax:336-578-3466
Practice Address - Street 1:236 RIVERBEND RD
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253
Practice Address - Country:US
Practice Address - Phone:336-578-3465
Practice Address - Fax:336-578-3466
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine