Healthcare Provider Details

I. General information

NPI: 1912965062
Provider Name (Legal Business Name): THOMAS M WOODCOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E BROADWAY
LOUISVILLE KY
40202-3700
US

IV. Provider business mailing address

PO BOX 776347
CHICAGO IL
60677-6347
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-2500
  • Fax: 502-629-2055
Mailing address:
  • Phone: 502-272-5052
  • Fax: 502-629-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number20737
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: