Provider Demographics
NPI:1033310537
Name:WOODRUFF, ANTHONY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 S POWER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3700
Mailing Address - Country:US
Mailing Address - Phone:480-409-5060
Mailing Address - Fax:480-409-5070
Practice Address - Street 1:1234 S POWER RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3700
Practice Address - Country:US
Practice Address - Phone:480-409-5060
Practice Address - Fax:480-409-5070
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46930208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ968044Medicaid
AZ968044Medicaid
AR5H311Medicare PIN
AZZ92891Medicare PIN