Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | M4662 | TX |
NPI | 1598965014 |
---|---|
Provider Name | Christian Woodbury |
First Address | San Antonio, TX 78216-6905 |
Second Address | San Antonio, TX 79229-6015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 13/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
74-3003947 | GROUPTAX ID (01) | TX |