Basic Information
Provider Information
NPI: 1033558523
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOLF
FirstName: CRAIG
MiddleName: JASON
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2500 FAIRWAY ST
Address2:  
City: DICKINSON
State: ND
PostalCode: 586012639
CountryCode: US
TelephoneNumber: (701) 456-4000
FaxNumber: 7014564800
Practice Location
Address1: 2500 FAIRWAY ST
Address2:  
City: DICKINSON
State: ND
PostalCode: 586012639
CountryCode: US
TelephoneNumber: (701) 456-4000
FaxNumber: 7014564800
Other Information
ProviderEnumerationDate: 06/18/2013
LastUpdateDate: 07/06/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XR73953AZY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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