Provider Demographics
NPI:1073686713
Name:WOODRUFF, ROGER D (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25455 BARTON ROAD, STE. 206-A
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-558-6505
Mailing Address - Fax:509-688-6792
Practice Address - Street 1:25455 BARTON RD STE 206A
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3130
Practice Address - Country:US
Practice Address - Phone:909-558-6505
Practice Address - Fax:909-558-6701
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073686713OtherNPI