Healthcare Provider Details

I. General information

NPI: 1083616338
Provider Name (Legal Business Name): DAVID A WOOG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BECKNER RD
SANTA FE NM
87507-3774
US

IV. Provider business mailing address

1631 HOSPITAL DR SUITE 110
SANTA FE NM
87505-4728
US

V. Phone/Fax

Practice location:
  • Phone: 505-477-2200
  • Fax:
Mailing address:
  • Phone: 505-982-7246
  • Fax: 505-983-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number93-434
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number157943
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: