Provider Demographics
NPI:1346619558
Name:WOODRUFF, MATTHEW SHAUN (IDC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SHAUN
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITE POND BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-3338
Mailing Address - Country:US
Mailing Address - Phone:210-551-3162
Mailing Address - Fax:
Practice Address - Street 1:POST OFFICE BOX 66038
Practice Address - Street 2:MARINE AIRCRAFT GROUP 31
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29904-6038
Practice Address - Country:US
Practice Address - Phone:843-228-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman