MEDICARE: DR. PAUL BLAKE WOODEN 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
1	207Q00000X	Family Medicine Physician	014165	ME

Other Identifiers

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

General Provider Information

NPI Number	:	1538148978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL BLAKE WOODEN MD

Provider Business Mailing Address
First Line	:	115 MT BLUE CIR
Second Line	:	SUITE 3
City	:	FARMINGTON
State	:	ME
Zip	:	04938-6239
Country	:	US
Telephone Number	:	207-778-6800
Fax Number	:	207-778-9800

Provider Business Practice Location Address
First Line	:	115 MT BLUE CIR
Second Line	:	SUITE 3
City	:	FARMINGTON
State	:	ME
Zip	:	04938-6239
Country	:	US
Telephone Number	:	207-778-6800
Fax Number	:	207-778-9800

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	12/13/2011

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