Individual
RUSSELL M WOLFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3419 JOHNSON ST, HOLLYWOOD, FL 33021
(954) 989-2800
(954) 989-2873
Mailing address
PO BOX 39209, FT. LAUDERDALE, FL 33339
(954) 851-9966
(954) 318-7360
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
62097
FL
207W00000X
Ophthalmology Physician
Primary
ME0062097
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100817
AV MED
FL
01
—
15197
BCBS OF FL
FL
01
—
180031939
RAILROAD MEDICARE
FL
01
—
1820665
CIGNA
FL
01
—
2078933
AETNA
FL
01
—
2504301
EMPLOYERS MUTUAL
FL
05
—
370552800
—
FL
Enumeration date
08/24/2006
Last updated
03/23/2021
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