Healthcare Provider Details

I. General information

NPI: 1245596451
Provider Name (Legal Business Name): JOHN SHAW WOFFORD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 WALNUT HILL LN STE 512
DALLAS TX
75231-4414
US

IV. Provider business mailing address

5310 HARVEST HILL RD STE 290
DALLAS TX
75230-5826
US

V. Phone/Fax

Practice location:
  • Phone: 214-369-8130
  • Fax: 214-369-7872
Mailing address:
  • Phone: 214-420-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberP8568
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberP8568
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: