=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174550727
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARL ALLEN WOODS JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2006
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 E 6TH ST STE 501
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32401-3661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-804-3040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4205 BELFORT RD STE 4015
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-3623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-450-6063
-----------------------------------------------------
Fax | 904-539-4091
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | ME173085
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------