Provider Demographics
NPI:1164612776
Name:BRUCE A WOODLING MD INC
Entity Type:Organization
Organization Name:BRUCE A WOODLING MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOODLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-482-6643
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-1088
Mailing Address - Country:US
Mailing Address - Phone:805-482-6643
Mailing Address - Fax:805-388-5546
Practice Address - Street 1:148 N BRENT ST STE 102
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2825
Practice Address - Country:US
Practice Address - Phone:805-482-6643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24570207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G24570Medicaid
CAG24570OtherSTATE LICENSE
CA1457433971OtherTYPE 1 NPI
CAG24570OtherSTATE LICENSE