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General NPI Number Information
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NPI Number | 1376345884
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Entity Type | Individual
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Provider Name | ETHAN RILEY WOODRUFF D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 200 HAWKINS DR
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City | IOWA CITY
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State | IA
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Zip | 52242-1009
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Country | US
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Telephone | 319-356-1616
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Fax | 319-356-2587
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Provider Business Mailing Address
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Address Line | 206 EDGEWOOD AVE
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City | JEFFERSON
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State | IA
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Zip | 50129-2757
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Country | US
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Telephone | 515-370-4963
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R-13552
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License Number State | IA
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