Provider Demographics
NPI:1346245966
Name:WOODHAM, DAVID BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:WOODHAM
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:PO BOX 6599
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-6599
Mailing Address - Country:US
Mailing Address - Phone:334-944-7073
Mailing Address - Fax:334-944-7058
Practice Address - Street 1:4300 W MAIN ST STE 405
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1086
Practice Address - Country:US
Practice Address - Phone:334-944-7073
Practice Address - Fax:334-944-7058
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9045207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61563OtherFLORIDA MEDICAID
AL000004093Medicaid
FL38754100Medicaid
AL000004093Medicaid
FL61563OtherFLORIDA MEDICAID