Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 28459 | WI |
NPI | 1144203225 |
---|---|
Provider Name | Dennis D Woodhall |
First Address | Conway, AR 72034-4967 |
Second Address | Conway, AR 72034-4967 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 19/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060071334 | RAILROAD MEDICARE (01) | WI |
13420 | DEAN (01) | WI |
30807900 | (05) | WI |
390807236A7 | UNITY (01) | WI |
B57725 | (02) | |
WI01P6 | JOHN DEERE (01) | WI |