MEDICARE: DR. BRUCE ALLEN WOODFORD 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	207Q00000X	Family Medicine Physician	OS-19906	FL

General Provider Information

NPI Number	:	1588634653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ALLEN WOODFORD D.O.

Provider Business Mailing Address
First Line	:	1016 THOMAS DR UNIT 262
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-7444
Country	:	US
Telephone Number	:	575-359-5406
Fax Number	:

Provider Business Practice Location Address
First Line	:	12216 PANAMA CITY BEACH PKWY STE D
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2728
Country	:	US
Telephone Number	:	850-708-7059
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	11/14/2023

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