Basic Information
| Provider Information | |||||||||
| NPI: | 1033558523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | JASON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 FAIRWAY ST | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586012639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014564000 | ||||||||
| FaxNumber: | 7014564800 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 FAIRWAY ST | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586012639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014564000 | ||||||||
| FaxNumber: | 7014564800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | R73953 | AZ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.