Provider Demographics
NPI:1407628860
Name:WOODBURY, ANDREW LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEE
Last Name:WOODBURY
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Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7140 SMOKE RANCH RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3157
Mailing Address - Country:US
Mailing Address - Phone:702-320-8111
Mailing Address - Fax:702-320-8112
Practice Address - Street 1:7140 SMOKE RANCH RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3157
Practice Address - Country:US
Practice Address - Phone:702-320-8111
Practice Address - Fax:702-320-8112
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2024-03-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant