Provider Demographics
NPI:1528140878
Name:WOOLF, KURTIS A (MD)
Entity type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:A
Last Name:WOOLF
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-8100
Mailing Address - Fax:
Practice Address - Street 1:3225 W GORDON AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5728
Practice Address - Country:US
Practice Address - Phone:801-397-6150
Practice Address - Fax:801-397-6151
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47739981205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870348215008Medicaid
005506607Medicare PIN
H25602Medicare UPIN
005531318Medicare PIN
UT000063707Medicare PIN
005522021Medicare PIN