Individual
MS. DIANA LEE WOLFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3801 S NATIONAL AVE, 5TH FLOOR, SPRINGFIELD, MO 65807-5210
(417) 269-7728
(417) 269-7729
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-7728
(417) 269-7729
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
04-30347
KS
207R00000X
Internal Medicine Physician
Primary
2002019572
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200003810A
—
KS
05
—
200003810B
—
KS
05
—
207626607
—
MO
01
—
611348
ANTHEM
MO
Enumeration date
08/24/2005
Last updated
12/17/2012
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