Provider Demographics
NPI:1417145392
Name:WOODROOF, DAWN ANDREA (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ANDREA
Last Name:WOODROOF
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40602-1430
Mailing Address - Country:US
Mailing Address - Phone:502-226-3858
Mailing Address - Fax:502-227-5081
Practice Address - Street 1:38 JOE T PETTY DRIVE
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-8553
Practice Address - Country:US
Practice Address - Phone:606-658-9535
Practice Address - Fax:270-266-4189
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA846962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43825OtherKENTUCKY BOARD OF MEDICAL LICENSURE
CAA84696OtherCA LICENSE NUMBER