Provider Demographics
NPI:1659351617
Name:WOODRUFF, ROBERT W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:WOODRUFF
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:452 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1556
Mailing Address - Country:US
Mailing Address - Phone:888-940-2722
Mailing Address - Fax:513-632-8898
Practice Address - Street 1:627 EASTLAND AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4501
Practice Address - Country:US
Practice Address - Phone:330-841-4661
Practice Address - Fax:330-841-4565
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35075650W208600000X
OH35.075650208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH153540OtherMEDICARE PTAN
OH2110870Medicaid
OHH176220OtherMEDICARE PTAN
OHH153540OtherMEDICARE PTAN
G67859Medicare UPIN