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1588667182

NPI Code Detail

MEDICARE: DR. BRUCE WOODALL MD

MEDICARE: DR. BRUCE WOODALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M9450	ID
2	207Q00000X	Family Medicine Physician	P3269	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76273	OTHER	ID	BLUE CROSS OF ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000010152435	OTHER	ID	REGENCE BS OF ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8DK990	OTHER	TX	BCBS OF TX
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0204370	OTHER	WA	WA LABOR & INDUSTRIES
8	601417300	OTHER		DEEIOC

General Provider Information

NPI Number	:	1588667182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE WOODALL MD

Provider Business Mailing Address
First Line	:	PO BOX 1610
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-9004
Country	:	US
Telephone Number	:	903-887-1011
Fax Number	:	903-887-9441

Provider Business Practice Location Address
First Line	:	801 W MAIN STREET
Second Line	:
City	:	GUN BARREL CITY
State	:	TX
Zip	:	75156-5312
Country	:	US
Telephone Number	:	903-887-1011
Fax Number	:	903-887-9441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/07/2024

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Practice Location Address:

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1033506019 — MRS. ALICE RENEE SPLINTER MD
Practice Location Address:

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Directions to “ DR. BRUCE WOODALL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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