MEDICARE: CARINA 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
1	207N00000X	Dermatology Physician	T5497	TX

General Provider Information

NPI Number	:	1942696950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARINA WOODRUFF M.D.

Provider Business Mailing Address
First Line	:	6601 VAUGHT RANCH RD STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78730-2309
Country	:	US
Telephone Number	:	512-628-0465
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 N WASHINGTON AVE STE 7300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1751
Country	:	US
Telephone Number	:	214-296-4477
Fax Number	:

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

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	07/14/2022

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