1972797421 NPI number — DENISE A. WOODY-GROSS, M.D., P.A.

Table of content: (NPI 1972797421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972797421 NPI number — DENISE A. WOODY-GROSS, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENISE A. WOODY-GROSS, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1972797421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 780836
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78278-0836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-593-0620
Provider Business Mailing Address Fax Number:
210-615-8027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7711 LOUIS PASTEUR STE 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-593-0620
Provider Business Practice Location Address Fax Number:
210-615-8027
Provider Enumeration Date:
08/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOODY-GROSS
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
210-593-0620

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  J8844 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 160240101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".