MEDICARE: DR. ALEXIS CRANE WOODRUFF 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	207L00000X	Anesthesiology Physician	35717	KY
2	207L00000X	Anesthesiology Physician	01062207	IN
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	35717	KY

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	:	1750377347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS CRANE WOODRUFF MD

Provider Business Mailing Address
First Line	:	5734 COVENTRY LANE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7141
Country	:	US
Telephone Number	:	260-436-7875
Fax Number	:

Provider Business Practice Location Address
First Line	:	5734 COVENTRY LANE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	45804-7141
Country	:	US
Telephone Number	:	260-436-7875
Fax Number	:	260-432-9812

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	09/07/2016

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