1679551725 NPI number — WILLIAM WALTER WOODRUFF III M.D.

Table of content: WILLIAM WALTER WOODRUFF III M.D. (NPI 1679551725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679551725 NPI number — WILLIAM WALTER WOODRUFF III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODRUFF
Provider First Name:
WILLIAM
Provider Middle Name:
WALTER
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679551725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1331 N. ELM ST.
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401-6304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-274-9617
Provider Business Mailing Address Fax Number:
336-482-2177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1331 N. ELM ST.
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-6304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-274-9617
Provider Business Practice Location Address Fax Number:
336-482-2177
Provider Enumeration Date:
01/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  27350 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 213625A . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89124 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8989124 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300033906 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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