Provider Demographics
NPI:1003037417
Name:WOO, JEFFERY ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ALLEN
Last Name:WOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1900 WEALTHY ST SE
Mailing Address - Street 2:STE 150
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2969
Mailing Address - Country:US
Mailing Address - Phone:616-459-3158
Mailing Address - Fax:616-988-0071
Practice Address - Street 1:1900 WEALTHY ST SE
Practice Address - Street 2:STE 150
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2969
Practice Address - Country:US
Practice Address - Phone:616-459-3158
Practice Address - Fax:616-988-0071
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301084065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003037417Medicaid
MIJW1104117952OtherBCBC MI
MI1003037417Medicaid