Active NPI
Bobby Joe Wolfe Jr.
- Public Health & General Preventive Medicine Physician
- Brandon, MS
National Provider Identifier
1740324698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health & General Preventive Medicine Physician
- License
- 07076
- Practice address
- 100 Tamberline St
Brandon, MS 39042-3164 - Phone
- (601) 825-2141
- NPI assigned
- Feb 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health & General Preventive Medicine Physician | 2083P0901X | 07076 | MS | Primary |
Addresses
Primary practice location
100 Tamberline St
Brandon, MS 39042-3164
Mailing address
100 Tamberline St
Brandon, MS 39042-3164
Phone (601) 825-2141
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00123676 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302825600000",
"number": "1740324698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 TAMBERLINE ST",
"city": "BRANDON",
"state": "MS",
"postal_code": "390423164",
"telephone_number": "601-825-2141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 TAMBERLINE ST",
"city": "BRANDON",
"state": "MS",
"postal_code": "390423164",
"telephone_number": "601-825-2141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFE",
"first_name": "BOBBY",
"middle_name": "JOE",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-16",
"last_updated": "2011-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "MS",
"license": "07076",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00123676",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brandon, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.