Basic Information
| Provider Information | |||||||||
| NPI: | 1770654261 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLKEN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | COMMANDER USA-MEDDAC-AK ATTN MCUC MMD QM (CREDENTIALS) | ||||||||
| Address2: | 1060 GAFFNEY RD STE 7440 | ||||||||
| City: | FT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997037440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534847 | ||||||||
| Practice Location | |||||||||
| Address1: | COMMANDER USA-MEDDAC-AK ATTN MCUC MMD QM (CREDENTIALS) | ||||||||
| Address2: | 1060 GAFFNEY RD STE 7440 | ||||||||
| City: | FT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997037440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073535418 | ||||||||
| FaxNumber: | 9073534847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207Q00000X | 01047378A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.