1477558195 NPI number — DR. ROBERT STEVEN WOLFF M.D.

Table of content: DR. ROBERT STEVEN WOLFF M.D. (NPI 1477558195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477558195 NPI number — DR. ROBERT STEVEN WOLFF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFF
Provider First Name:
ROBERT
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477558195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 S STEPHANIE ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89012-5731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-202-4776
Provider Business Mailing Address Fax Number:
702-202-6110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3475 GS RICHARDS BLVD STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89703-8462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-841-2000
Provider Business Practice Location Address Fax Number:
775-841-4200
Provider Enumeration Date:
06/17/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  7782 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: G81859 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1477558195 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".