Healthcare Provider Details

I. General information

NPI: 1821154881
Provider Name (Legal Business Name): BRENT L WOODBURY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N FIRST ST SUITE 105
FRESNO CA
93710
US

IV. Provider business mailing address

6700 N FIRST ST SUITE 105
FRESNO CA
93710
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-0757
  • Fax: 559-431-0758
Mailing address:
  • Phone: 559-431-0757
  • Fax: 559-431-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: