Provider Demographics
NPI:1689068843
Name:WOODWORTH, PAUL ALAN
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALAN
Last Name:WOODWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 S 525 W
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-9132
Mailing Address - Country:US
Mailing Address - Phone:317-605-6188
Mailing Address - Fax:
Practice Address - Street 1:3499 S 525 W
Practice Address - Street 2:
Practice Address - City:TRAFALGAR
Practice Address - State:IN
Practice Address - Zip Code:46181-9132
Practice Address - Country:US
Practice Address - Phone:317-605-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program