Provider Demographics
NPI:1851414593
Name:FLORENCE WOOTEN, M.D., P.A.
Entity Type:Organization
Organization Name:FLORENCE WOOTEN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-652-9898
Mailing Address - Street 1:2000 CRAWFORD ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9089
Mailing Address - Country:US
Mailing Address - Phone:713-652-9898
Mailing Address - Fax:713-652-9899
Practice Address - Street 1:2000 CRAWFORD ST STE 1200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9089
Practice Address - Country:US
Practice Address - Phone:713-652-9898
Practice Address - Fax:713-652-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05875TG152W00000X
TX026445156FX1800X
TXH1060207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4012560001OtherCIGNA
TX4012560001OtherPALMETTO (DMERC)
TX4012560001OtherCIGNA
TX4012560001OtherPALMETTO (DMERC)
TX=========Medicare PIN