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General NPI Number Information
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NPI Number | 1053606236
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Entity Type | Individual
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Provider Name | JHADE WOODALL MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 3200 CHANNING WAY STE 206
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7546
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Country | US
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Telephone | 208-529-2230
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Fax | 208-453-6142
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Provider Business Mailing Address
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Address Line | PO BOX 277381
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City | ATLANTA
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State | GA
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Zip | 30384-2358
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | M-16557
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License Number State | ID
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