Healthcare Provider Details

I. General information

NPI: 1598965014
Provider Name (Legal Business Name): CHRISTIAN WOODBURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 BABCOCK ROAD SUITE 700
SAN ANTONIO TX
79229-6015
US

IV. Provider business mailing address

400 CONCORD PLAZA DR SUITE 300
SAN ANTONIO TX
78216-6905
US

V. Phone/Fax

Practice location:
  • Phone: 210-804-5506
  • Fax: 210-804-5510
Mailing address:
  • Phone: 210-804-5506
  • Fax: 210-804-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberM4662
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: