Provider Demographics
NPI:1235197492
Name:WOODWORTH, PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:WOODWORTH
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 1:10099 RIDGEGATE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5532
Mailing Address - Country:US
Mailing Address - Phone:303-788-7700
Mailing Address - Fax:303-788-8982
Practice Address - Street 1:10099 RIDGEGATE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5532
Practice Address - Country:US
Practice Address - Phone:303-788-7700
Practice Address - Fax:303-788-8982
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4418208600000X
CODR0066084208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157757001Medicaid
ARI40001Medicare UPIN
AR5N315Medicare ID - Type Unspecified