Healthcare Provider Details

I. General information

NPI: 1598713653
Provider Name (Legal Business Name): DOUGLAS A WOODBURN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 LOMA VISTA RD SUITE C
VENTURA CA
93003-2900
US

IV. Provider business mailing address

2929 LOMA VISTA ROAD SUITE C
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-0222
  • Fax: 805-641-0272
Mailing address:
  • Phone: 805-641-0222
  • Fax: 805-641-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG53167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: