Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 29461 | AL |
N | 207ND0900X | Dermatopathologist | 29461 | AL |
NPI | 1437276276 |
---|---|
Provider Name | Dr. Matthew Travis Woods |
First Address | Gilbert, AZ 85295-6221 |
Second Address | Gilbert, AZ 85295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 31/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
757618 | (05) | AZ |