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General NPI Number Information
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NPI Number | 1124365523
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Entity Type | Organization
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Legal Business Name | WOOLDRIDGE MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 1345 W BAY DR SUITE 405
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City | LARGO
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State | FL
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Zip | 33770-2282
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Country | US
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Telephone | 727-213-9888
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 W BAY DR SUITE 405
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City | LARGO
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State | FL
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Zip | 33770-2282
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Country | US
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Telephone | 727-213-9888
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN / OWNER
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Name | DR. STANLEY S MOLES
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Credential | MD
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Telephone | 727-213-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 9287
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License Number State | FL
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