MEDICARE: DR. ROBERT D WOODALL D. M. 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	122300000X	Dentist	3395	AL

General Provider Information

NPI Number	:	1346338944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT D WOODALL D. M. D.

Provider Business Mailing Address
First Line	:	3228 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-5805
Country	:	US
Telephone Number	:	256-442-1797
Fax Number	:

Provider Business Practice Location Address
First Line	:	3228 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-5805
Country	:	US
Telephone Number	:	256-442-1797
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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