Provider Demographics
NPI:1326204017
Name:WOODBURY, PHILIP WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WAYNE
Last Name:WOODBURY
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 1:12758 DEVON LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9448
Mailing Address - Country:US
Mailing Address - Phone:317-844-3806
Mailing Address - Fax:
Practice Address - Street 1:12758 DEVON LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9448
Practice Address - Country:US
Practice Address - Phone:317-844-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032860A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist