MEDICARE: RICHARD WOOTAN, MD,PA

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	208600000X	Surgery Physician	E9034	TX

General Provider Information

NPI Number	:	1891004255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD WOOTAN, MD,PA

Provider Business Mailing Address
First Line	:	8111 LBJ FWY
Second Line	:	STE 835
City	:	DALLAS
State	:	TX
Zip	:	75251-1313
Country	:	US
Telephone Number	:	972-644-3232
Fax Number	:	972-644-7375

Provider Business Practice Location Address
First Line	:	9335 GARLAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-3639
Country	:	US
Telephone Number	:	214-324-2824
Fax Number	:	214-324-2825

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. RICHARD WOOTAN
Credential	:	MD
Telephone Number	:	214-324-2824

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	10/04/2010

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