Individual
DR. CLINTON GROVER WOLBOLDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7601 QUAKER AVE, LUBBOCK, TX 79424-3360
(806) 725-9603
(806) 725-9500
Mailing address
3420 22ND PL, LUBBOCK, TX 79410-1314
(806) 725-5844
(806) 723-6532
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K4298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080168552
RAILROAD MEDICARE
TX
05
—
111857209
—
TX
05
—
28801385
—
NM
Enumeration date
04/11/2006
Last updated
10/31/2011
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