=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881092799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JW MEDICAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2014
-----------------------------------------------------
Last Update Date | 12/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9000 CROW CANYON RD S286
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94506-1189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-208-1422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9000 CROW CANYON RD S286
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94506-1189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-208-1422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SHARON WOODBURY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 925-208-1422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A5306
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------