MEDICARE: MR. BRENT ALLEN WOODSON DO

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	207RP1001X	Pulmonary Disease Physician	54118	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710133491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRENT ALLEN WOODSON DO

Provider Business Mailing Address
First Line	:	PO BOX 1727
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81502-1727
Country	:	US
Telephone Number	:	970-263-2680
Fax Number	:	970-263-2684

Provider Business Practice Location Address
First Line	:	2373 G RD STE 160
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1003
Country	:	US
Telephone Number	:	970-263-2680
Fax Number	:	970-263-2684

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

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	06/06/2022

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