Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 21119 | CO |
NPI | 1023034071 |
---|---|
Provider Name | Dr. John Buford Woodward III |
First Address | Wheat Ridge, CO 80033 |
Second Address | Wheat Ridge, CO 80033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 05/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01211192 | (05) | CO |
017607 | KAISER COMMERCIAL NUMBER (01) | CO |
D23883 | (02) |