Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 5101012285 | MI |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 02002913A | IN |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 5101012285 | MI |
NPI | 1750369757 |
---|---|
Provider Name | Dr. Patrick John Woodman |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Farmington Hills, MI 48334-3275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 01/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200520680 | (05) | IN |