Provider Demographics
NPI:1487781993
Name:WOLFE, KIRK DANA (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:DANA
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 AQUINAS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1203
Mailing Address - Country:US
Mailing Address - Phone:503-635-9342
Mailing Address - Fax:503-232-0138
Practice Address - Street 1:1500 NE IRVING ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2265
Practice Address - Country:US
Practice Address - Phone:503-233-4356
Practice Address - Fax:503-232-0138
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR182152084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry