Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 2017006417 | MO |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 30576 | NE |
NPI | 1154682052 |
---|---|
Provider Name | Dr. Chase Colton Woodward |
First Address | Omaha, NE 68154-5336 |
Second Address | Omaha, NE 68154-5336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2012 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47081304012 | (05) | NE |