Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | AP140285 | TX |
NPI | 1255993879 |
---|---|
Provider Name | Matthew Aaron Woodworth |
First Address | Fort Worth, TX 76126-6461 |
Second Address | Burleson, TX 76028-9501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2019 |
Last Update Date | 03/07/2019 |