Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | NC |
NPI | 1316198856 |
---|---|
Provider Name | Howard P Woodbury |
First Address | Clemmons, NC 27012-8944 |
Second Address | Clemmons, NC 27012-8944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 02/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046VK | BLUE CROSS BLUE SHIELD (01) | |
1028122 | UNITED HEALTHCARE (01) | NC |
7704197 | (05) | NC |
7795189 | (05) | NC |
807510 | BLUE MEDICARE (01) | NC |