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General NPI Number Information
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NPI Number | 1972066678
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Entity Type | Individual
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Provider Name | TARAH WOODLE MD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 03/09/2025
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR
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City | JBSA FT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 301-520-6905
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Fax |
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Provider Business Mailing Address
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Address Line | 3551 ROGER BROOKE DR
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City | JBSA FT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101271559
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 13917929-1205
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License Number State | UT
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