Provider Demographics
NPI:1558333740
Name:WOOTTON, WENDY (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:WOOTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S 63RD ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1619
Mailing Address - Country:US
Mailing Address - Phone:480-641-3937
Mailing Address - Fax:480-924-5094
Practice Address - Street 1:220 S 63RD ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1619
Practice Address - Country:US
Practice Address - Phone:480-641-3937
Practice Address - Fax:480-924-5094
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17689207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD00582Medicare UPIN
AZZ18WCLBB03Medicare PIN