Provider Demographics
NPI:1700028578
Name:WOFFORD, TARA LAUREN (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LAUREN
Last Name:WOFFORD
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 1:505 NE 87TH AVE
Mailing Address - Street 2:SUITE 46.7
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1989
Mailing Address - Country:US
Mailing Address - Phone:360-828-5396
Mailing Address - Fax:360-828-5455
Practice Address - Street 1:505 NE 87TH AVE
Practice Address - Street 2:SUITE 46.7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1989
Practice Address - Country:US
Practice Address - Phone:360-828-5396
Practice Address - Fax:360-828-5455
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60270941207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program