Healthcare Provider Details

I. General information

NPI: 1316944283
Provider Name (Legal Business Name): JONATHAN H WOODCOCK MD & ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8515 PEARL ST 203
THORNTON CO
80229-4809
US

IV. Provider business mailing address

8515 PEARL ST 203
THORNTON CO
80229-4809
US

V. Phone/Fax

Practice location:
  • Phone: 303-288-7882
  • Fax: 303-288-7874
Mailing address:
  • Phone: 303-288-7882
  • Fax: 303-288-7874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number29436
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29436
License Number StateCO

VIII. Authorized Official

Name: JONATHAN HUGH WOODCOCK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-288-7882