Provider Demographics
NPI:1669671061
Name:GEORGE A WOOMING, MD, PA
Entity type:Organization
Organization Name:GEORGE A WOOMING, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOMING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-661-5476
Mailing Address - Street 1:12200 PARK CENTRAL DR
Mailing Address - Street 2:#220
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12200 PARK CENTRAL DR STE 220
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3220
Practice Address - Country:US
Practice Address - Phone:972-661-5476
Practice Address - Fax:972-661-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9449174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB143347Medicare PIN
TXTXB143350Medicare PIN