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NPI Code Detail

MEDICARE: DR. BLANE A WOODFIN MD

MEDICARE: DR. BLANE A WOODFIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician6665AWY

General Provider Information

NPI Number : 1104825025
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BLANE A WOODFIN MD
Provider Business Mailing Address
First Line : PO BOX 10490
Second Line :
City : JACKSON
State : WY
Zip : 83002-0490
Country : US
Telephone Number : 307-733-3900
Fax Number : 307-732-0925
Provider Business Practice Location Address
First Line : 555 E BROADWAY
Second Line :
City : JACKSON
State : WY
Zip : 83001-9496
Country : US
Telephone Number : 307-733-3900
Fax Number : 307-732-0925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 07/09/2007

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