Provider Demographics
NPI:1457433971
Name:WOODLING, BRUCE ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ARTHUR
Last Name:WOODLING
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 1:643 CRESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8434
Mailing Address - Country:US
Mailing Address - Phone:805-482-6643
Mailing Address - Fax:805-388-5546
Practice Address - Street 1:148 N BRENT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2867
Practice Address - Country:US
Practice Address - Phone:805-482-6643
Practice Address - Fax:805-388-5546
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24570207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG24570OtherBLUE SHIELD
CA00G245700Medicaid
CA00G245700Medicaid
CAA 42303Medicare UPIN