Provider Demographics
NPI:1023064177
Name:WOO, WAYNE (MD MA CCD FACE CDE)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:WOO
Suffix:
Gender:M
Credentials:MD MA CCD FACE CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 COURTHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9562
Mailing Address - Country:US
Mailing Address - Phone:601-932-1223
Mailing Address - Fax:601-932-1291
Practice Address - Street 1:2610 COURTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9562
Practice Address - Country:US
Practice Address - Phone:601-932-1223
Practice Address - Fax:601-932-1291
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17286207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSG73688Medicare UPIN
MS460000011Medicare ID - Type Unspecified