Provider Demographics
NPI:1093703530
Name:WOODMANSEE, JAMES A III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:WOODMANSEE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2230 N UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1509
Mailing Address - Country:US
Mailing Address - Phone:801-377-3413
Mailing Address - Fax:801-655-1890
Practice Address - Street 1:2230 N UNIVERSITY PKWY
Practice Address - Street 2:SUITE 1A
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1509
Practice Address - Country:US
Practice Address - Phone:801-377-3413
Practice Address - Fax:801-655-1940
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1817981205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT308184OtherDMBA
UT1093703530Medicaid
UT000057007OtherMEDICARE ID PIN
UT107007064102OtherSELECTHEALTH
UT0100642OtherUNITED HEALTHCARE
UTQM0000000779OtherALTIUS
UT4584585OtherAETNA
UT005700701Medicare PIN
UT107007064102OtherSELECTHEALTH