1215931951 NPI number — DR. LEE PAUL WOODRUFF DPM

Table of content: DR. LEE PAUL WOODRUFF DPM (NPI 1215931951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215931951 NPI number — DR. LEE PAUL WOODRUFF DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODRUFF
Provider First Name:
LEE
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1215931951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1815 EXECUTIVE SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-6086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-933-0041
Provider Business Mailing Address Fax Number:
870-933-0531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1815 EXECUTIVE SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-6086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-933-0041
Provider Business Practice Location Address Fax Number:
870-933-0531
Provider Enumeration Date:
06/10/2005

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: 213E00000X , with the licence number:  117 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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