Provider Demographics
NPI:1326062894
Name:WOODWORTH, WILLIAM H (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:WOODWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 E PIKES PEAK AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-7024
Mailing Address - Country:US
Mailing Address - Phone:719-635-5657
Mailing Address - Fax:719-578-9014
Practice Address - Street 1:2504 E PIKES PEAK AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-7024
Practice Address - Country:US
Practice Address - Phone:719-635-5657
Practice Address - Fax:719-578-9014
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01190800Medicaid