Healthcare Provider Details

I. General information

NPI: 1215921432
Provider Name (Legal Business Name): BRIAN ERIC WOODRUFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HOUGHTON AVE
SAGINAW MI
48602-5303
US

IV. Provider business mailing address

1000 HOUGHTON AVE
SAGINAW MI
48602-5303
US

V. Phone/Fax

Practice location:
  • Phone: 899-746-7500
  • Fax:
Mailing address:
  • Phone: 899-746-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301077699
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number4301077699
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: