MEDICARE: DR. CHRISTOPHER WOODMAN PH.D.

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	103TC0700X	Clinical Psychologist	PY0004105	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73375	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1215926217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER WOODMAN PH.D.

Provider Business Mailing Address
First Line	:	12705 NW 18TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-5408
Country	:	US
Telephone Number	:	954-346-7741
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 CORAL HILLS DRIVE
Second Line	:	SUITE 340
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4042
Country	:	US
Telephone Number	:	954-752-2700
Fax Number	:	954-752-7745

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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