Provider Demographics
NPI:1578659017
Name:WOODS, PHILLIP H (DO)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:H
Last Name:WOODS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 E ORMAN AVE
Mailing Address - Street 2:STE A345
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004
Mailing Address - Country:US
Mailing Address - Phone:719-566-1632
Mailing Address - Fax:719-566-0147
Practice Address - Street 1:1925 E ORMAN AVE
Practice Address - Street 2:STE A345
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004
Practice Address - Country:US
Practice Address - Phone:719-566-1632
Practice Address - Fax:719-566-0147
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01289941Medicaid
12292Medicare ID - Type Unspecified
CO01289941Medicaid