Provider Demographics
NPI:1346443082
Name:C. BRIEN WOFFORD DO, PA
Entity Type:Organization
Organization Name:C. BRIEN WOFFORD DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-627-8300
Mailing Address - Street 1:221 HUNTERS VLG
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4742
Mailing Address - Country:US
Mailing Address - Phone:830-627-8300
Mailing Address - Fax:830-627-8312
Practice Address - Street 1:221 HUNTERS VLG
Practice Address - Street 2:SUITE B
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4742
Practice Address - Country:US
Practice Address - Phone:830-627-8300
Practice Address - Fax:830-627-8312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046NWOtherBLUE CROSS PROVIDER ID
TX157967401Medicaid
TX00553UMedicare ID - Type Unspecified
TX157967401Medicaid