Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | FSJ499 | TN |
NPI | 1154313591 |
---|---|
Provider Name | Michael J Woodbury |
First Address | Bartlett, TN 38133-4023 |
Second Address | Bartlett, TN 38133-4023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 01/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070007680 | RR MEDICARE (01) | AR |
070011483 | RR MEDICARE (01) | TN |
126719001 | (05) | AR |
F5J499 | (02) | TN |
F85962 | (02) | AR |