Healthcare Provider Details

I. General information

NPI: 1457329054
Provider Name (Legal Business Name): MICHAEL SCOTT WOODS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR SUITE 110
SANTA FE NM
87505-7670
US

IV. Provider business mailing address

455 SAINT MICHAELS DR MEDICAL STAFF OFFICE
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-954-8720
  • Fax:
Mailing address:
  • Phone: 505-820-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2005-0673
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: