Individual
MARK WOLVERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 MEDICAL CENTER DR, FAIRMONT, MN 56031-4575
(507) 238-8555
Mailing address
800 MEDICAL CENTER DR, PO BOX 800, FAIRMONT, MN 56031-4575
(507) 238-8555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21418
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-12157
MEDICA
MN
05
—
116281
—
MN
01
—
22379
SIOUX VALLEY
MN
01
—
5T432WO
BLUE CROSS
MN
05
—
5T432WO
—
MN
01
—
6848
AVERA
MN
01
—
705219
ARAZ
MN
05
—
903294
—
IA
01
—
A015
CHAMPUS
MN
01
—
HP30229
HEALTHPARTNERS
MN
01
—
MH9041000384
PREFERREDONE
MN
Enumeration date
12/23/2005
Last updated
07/09/2007
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