MEDICARE: DR. DOMINIC DEAN 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207X00000X	Orthopaedic Surgery Physician	20A17497	CA

General Provider Information

NPI Number	:	1912403668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC DEAN WOODSON DO

Provider Business Mailing Address
First Line	:	9300 VALLEY CHILDRENS PL # SC05
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93636-8761
Country	:	US
Telephone Number	:	559-353-5700
Fax Number	:	559-353-5708

Provider Business Practice Location Address
First Line	:	2301 ERWIN ROAD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-4404
Country	:	US
Telephone Number	:	919-684-8111
Fax Number	:

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

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	07/18/2024

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