Provider Demographics
NPI:1619984341
Name:WOOTEN, MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:2121 LAKE AVE
Mailing Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS (11)
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5100
Mailing Address - Country:US
Mailing Address - Phone:260-460-1311
Mailing Address - Fax:260-421-1827
Practice Address - Street 1:2121 LAKE AVE
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS (11)
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5100
Practice Address - Country:US
Practice Address - Phone:260-460-1311
Practice Address - Fax:260-421-1827
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6716207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology