Provider Demographics
NPI:1073905519
Name:WOODLY FOOT AND ANKLE SPECIALISTS, PC
Entity Type:Organization
Organization Name:WOODLY FOOT AND ANKLE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:682-323-9205
Mailing Address - Street 1:5505 MILFORD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4972
Mailing Address - Country:US
Mailing Address - Phone:682-323-9306
Mailing Address - Fax:
Practice Address - Street 1:7208 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8693
Practice Address - Country:US
Practice Address - Phone:817-284-8271
Practice Address - Fax:817-284-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1764213E00000X, 213EP1101X, 213ES0103X
TX1464213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty