Healthcare Provider Details

I. General information

NPI: 1871607937
Provider Name (Legal Business Name): ROBERT ORLO WOODBURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 4TH ST STE 200
SANTA ROSA CA
95404-3601
US

IV. Provider business mailing address

3536 MENDOCINO AVE STE 200
SANTA ROSA CA
95403-3634
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-2100
  • Fax: 707-523-0616
Mailing address:
  • Phone: 707-525-6485
  • Fax: 707-523-0616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG77680
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG77680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: