Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | J3658 | TX |
NPI | 1164487260 |
---|---|
Provider Name | Philip M Woodall |
First Address | Round Rock, TX 78664-5606 |
Second Address | Round Rock, TX 78664-5606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 27/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E66840 | (02) | TX |