Provider Demographics
NPI:1720099989
Name:WOODBURY, MICHEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:A
Last Name:WOODBURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:A
Other - Last Name:WOODBURY-FARINA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:307 ELEANOR ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-754-0872
Mailing Address - Fax:787-758-9690
Practice Address - Street 1:307 ELEANOR ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-754-0872
Practice Address - Fax:787-758-9690
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPRLLC#63632084P0804X
PR63632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry