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General NPI Number Information
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NPI Number | 1235570938
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Entity Type | Organization
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Legal Business Name | WOODRUFF FAMILY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 311 W MAIN ST
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City | WILBURTON
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State | OK
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Zip | 74578-4047
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Country | US
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Telephone | 918-465-0001
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Fax | 918-465-0003
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Provider Business Mailing Address
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Address Line | 311 W MAIN ST
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City | WILBURTON
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State | OK
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Zip | 74578-4047
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Country | US
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Telephone | 918-465-0001
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Fax | 918-465-0003
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. ROBERT A. WOODRUFF
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Credential | D.O.
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Telephone | 918-465-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2209
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License Number State | OK
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