Provider Demographics
NPI:1427329762
Name:WOLFE, CHARLES ROBERT (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ROBERT
Last Name:WOLFE
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 1:16320 E LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9571
Mailing Address - Country:US
Mailing Address - Phone:509-924-1412
Mailing Address - Fax:
Practice Address - Street 1:16320 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-9571
Practice Address - Country:US
Practice Address - Phone:509-924-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine