Provider Demographics
NPI:1891109005
Name:WOOTEN, JOHN PERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PERRY
Last Name:WOOTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SWEETBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3008
Mailing Address - Country:US
Mailing Address - Phone:979-732-5771
Mailing Address - Fax:979-732-6922
Practice Address - Street 1:100 SWEETBRIAR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934
Practice Address - Country:US
Practice Address - Phone:817-702-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7631207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty