Individual
MR. BRUCE CARLISLE WOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
603 NORTHTOWN, MOUNTAIN HOME, AR 72653-3121
(870) 425-5180
(870) 425-5185
Mailing address
603 NORTHTOWN, MOUNTAIN HOME, AR 72653-3121
(870) 425-5180
(870) 425-5185
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT2246
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143668742
—
AR
01
—
650019382
PALMETTO GBA RR MEDICARE
AR
Enumeration date
03/30/2006
Last updated
11/17/2009
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