Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0431478 | KS |
N | 208600000X | Surgeon | 0431478 | KS |
Y | 2086S0129X | Vascular Surgeon | 04-31478 | KS |
NPI | 1053533349 |
---|---|
Provider Name | Jason Daniel Woolard |
First Address | Wichita, KS 67214-4923 |
Second Address | Wichita, KS 67226-2022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 02/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016899011 | (02) | |
200654750A | (05) | KS |