Individual
NICHOLAS THOMAS WOLFGANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10150 SE 32ND AVE, MILWAUKIE, OR 97222-6516
(503) 513-8641
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD205420
OR
Other
Enumeration date
07/12/2016
Last updated
04/26/2023
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