Basic Information
| Provider Information | |||||||||
| NPI: | 1396764932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 E MERRITT ISLAND CSWY | ||||||||
| Address2: | SUITE 209 #405 | ||||||||
| City: | MERRITT ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329523699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107781933 | ||||||||
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| Practice Location | |||||||||
| Address1: | 630 W DIVISION ST | ||||||||
| Address2: | SUITE F | ||||||||
| City: | DOVER | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199042760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026743366 | ||||||||
| FaxNumber: | 3026743360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/20/2012 | ||||||||
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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 | 2084F0202X | C2-0003033 | DE | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry | 2084F0202X | H0032854 | MD | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 609550002 | 05 | MD | MEDICAID | AW2190041 | 01 | DEA | OTHER | D00343 | 01 | DE | CONTROLLED SUBSTANCE LICE | OTHER | 262456700 | 05 | FL | MEDICAID | H0032854 | 01 | MD | DHMH | OTHER | 609550001 | 05 | MD | MEDICAID | OS 8277 | 01 | FL | ST OF FL DEPT OF HEALTH L | OTHER | BW7347392 | 01 | FL | DEA FLORIDA | OTHER | 609550004 | 05 | MD | MEDICAID | C2-0003033 | 01 | DE | PHYSICIAN LICENSE | OTHER |