Healthcare Provider Details

I. General information

NPI: 1184771057
Provider Name (Legal Business Name): AUBAINE M WOODS-STAPLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 STATE ROAD 46 W
BATESVILLE IN
47006-1487
US

IV. Provider business mailing address

124 STATE ROAD 46 W
BATESVILLE IN
47006-1487
US

V. Phone/Fax

Practice location:
  • Phone: 812-933-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46711
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01079507A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: