Provider Demographics
NPI:1366606923
Name:WOLFE, ERIC CHRISTOPHER (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CHRISTOPHER
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1408 EAST ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-4402
Mailing Address - Country:US
Mailing Address - Phone:620-365-3115
Mailing Address - Fax:620-365-7717
Practice Address - Street 1:440 E TAMPA ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1131
Practice Address - Country:US
Practice Address - Phone:417-851-1551
Practice Address - Fax:417-832-8275
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-34960207Q00000X
MO2017016279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017016279OtherMISSOURI PROFESSIONAL LICENSE