Provider Demographics
NPI:1275577637
Name:WOODDELL, CHARLES JACKSON (RDMS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JACKSON
Last Name:WOODDELL
Suffix:
Gender:M
Credentials:RDMS
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Mailing Address - Street 1:1518 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3927
Mailing Address - Country:US
Mailing Address - Phone:505-921-3827
Mailing Address - Fax:505-434-5624
Practice Address - Street 1:2474 INDIAN WELLS RD.
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-3927
Practice Address - Country:US
Practice Address - Phone:505-921-3827
Practice Address - Fax:505-434-5624
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM1069302471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography