Provider Demographics
NPI:1083616338
Name:WOOG, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:WOOG
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 1:1631 HOSPITAL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4728
Mailing Address - Country:US
Mailing Address - Phone:505-982-7246
Mailing Address - Fax:505-983-4812
Practice Address - Street 1:1631 HOSPITAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4728
Practice Address - Country:US
Practice Address - Phone:505-982-7246
Practice Address - Fax:505-983-4812
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-434207LP2900X
NY157943207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ315243Medicaid
NMNM009C94OtherBLUE CROSS BLUE SHIELD
CO46503242Medicaid
NC7613840Medicaid
UT850210604008Medicaid
NM48105Medicaid
NM28032Medicaid
NMNM009C94OtherBLUE CROSS BLUE SHIELD
UT850210604008Medicaid