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NPI Code Detail

MEDICARE: DR. RHONDA L WOOLWINE MD

MEDICARE: DR. RHONDA L WOOLWINE 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
12080A0000XPediatric Adolescent Medicine PhysicianME62509FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285607242
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RHONDA L WOOLWINE MD
Provider Business Mailing Address
First Line : PO BOX 45443
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84145-0443
Country : US
Telephone Number : 904-202-1032
Fax Number : 904-376-4107
Provider Business Practice Location Address
First Line : 2140 SMITH ST
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-5554
Country : US
Telephone Number : 904-269-2140
Fax Number : 904-376-4107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 12/21/2018

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Directions to “ DR. RHONDA L WOOLWINE MD” Practice Location

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