Provider Demographics
NPI:1336243070
Name:DUANE M WOOTEN M.D. PC
Entity Type:Organization
Organization Name:DUANE M WOOTEN M.D. PC
Other - Org Name:DUANE M WOOTEN M.D. PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-374-4937
Mailing Address - Street 1:515 W BUCKEYE RD STE 306
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-2650
Mailing Address - Country:US
Mailing Address - Phone:602-374-4937
Mailing Address - Fax:602-388-4261
Practice Address - Street 1:515 W BUCKEYE RD STE 306
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2650
Practice Address - Country:US
Practice Address - Phone:602-374-4937
Practice Address - Fax:602-388-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ270843OtherAHCCCS