Basic Information
| Provider Information | |||||||||
| NPI: | 1134268006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLFF | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1323 S 27TH ST | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | NEDERLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776276294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097295400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 W. ARBOR DR | ||||||||
| Address2: | MPF - L044 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921038755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195437636 | ||||||||
| FaxNumber: | 6195436923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/05/2016 | ||||||||
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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 | 2085B0100X | A102690 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | 23818 | OK | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | N2886 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2029530-01 | 05 | TX | MEDICAID |