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NPI Code Detail

MEDICARE: MICHAEL M WOODRUFF M.D.

MEDICARE: MICHAEL M WOODRUFF 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
1207P00000XEmergency Medicine Physician222533MA
2207P00000XEmergency Medicine Physician363890-1205UT

General Provider Information

NPI Number : 1639268121
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL M WOODRUFF M.D.
Provider Business Mailing Address
First Line : P.O. BOX 30180
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84130-0180
Country : US
Telephone Number : 801-269-2500
Fax Number : 801-269-2690
Provider Business Practice Location Address
First Line : 5121 S. COTTONWOOD STREET
Second Line :
City : MURRAY
State : UT
Zip : 84157
Country : US
Telephone Number : 801-269-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 12/27/2007

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Directions to “ MICHAEL M WOODRUFF M.D.” Practice Location

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