Healthcare Provider Details

I. General information

NPI: 1073554754
Provider Name (Legal Business Name): ROBERT A WOODRUFF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W MAIN ST
WILBURTON OK
74578-4047
US

IV. Provider business mailing address

311 W MAIN ST
WILBURTON OK
74578-4047
US

V. Phone/Fax

Practice location:
  • Phone: 918-465-0001
  • Fax: 918-465-0003
Mailing address:
  • Phone: 918-465-0001
  • Fax: 918-465-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2209
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: