Individual
DR. JOSHUA P WOLFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
233 S MAIN ST, LICKING, MO 65542-0047
(573) 674-3011
(573) 674-4765
Mailing address
PO BOX 47, LICKING, MO 65542-0047
(573) 674-3011
(573) 674-4765
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2013029561
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316262280
—
MO
01
—
26D0679044
CLIA
MO
Enumeration date
04/02/2010
Last updated
08/09/2013
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