Healthcare Provider Details

I. General information

NPI: 1659351617
Provider Name (Legal Business Name): ROBERT W. WOODRUFF JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 EASTLAND AVE SE STE 201
WARREN OH
44484-4501
US

IV. Provider business mailing address

452 BROADWAY AVE
YOUNGSTOWN OH
44504-1556
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4661
  • Fax: 330-841-4565
Mailing address:
  • Phone: 888-940-2722
  • Fax: 513-632-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35075650W
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.075650
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: