Provider Demographics
NPI:1093968158
Name:PERSONS, ROY WOODVALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:WOODVALL
Last Name:PERSONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10522 BERMUDA ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2720
Mailing Address - Country:US
Mailing Address - Phone:813-436-0293
Mailing Address - Fax:
Practice Address - Street 1:309 S FIELDING AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2224
Practice Address - Country:US
Practice Address - Phone:813-436-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical