MEDICARE: PHILIP M WOODALL D.O.

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
1	207QA0505X	Adult Medicine Physician	J3658	TX

General Provider Information

NPI Number	:	1164487260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP M WOODALL D.O.

Provider Business Mailing Address
First Line	:	1404 LAKE BLUFF CV
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5606
Country	:	US
Telephone Number	:	512-246-6170
Fax Number	:	512-246-6174

Provider Business Practice Location Address
First Line	:	1404 LAKE BLUFF CV
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5606
Country	:	US
Telephone Number	:	512-246-6170
Fax Number	:	512-246-6174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	01/27/2010

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