Provider Demographics
NPI:1225314271
Name:WOOTEN, WILLIAM GODFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GODFREY
Last Name:WOOTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4231
Mailing Address - Country:US
Mailing Address - Phone:812-402-1430
Mailing Address - Fax:
Practice Address - Street 1:839 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4231
Practice Address - Country:US
Practice Address - Phone:812-402-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027612A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine