Healthcare Provider Details

I. General information

NPI: 1285010488
Provider Name (Legal Business Name): GERALD WAYNE WOODMAN LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W EXPRWY 83 STE #4
PHARR TX
78577
US

IV. Provider business mailing address

1210 W EXPRWY 83 STE #4
PHARR TX
78577
US

V. Phone/Fax

Practice location:
  • Phone: 956-782-5525
  • Fax: 956-782-5500
Mailing address:
  • Phone: 956-782-5525
  • Fax: 956-782-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number142877
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: