Provider Demographics
NPI:1740251586
Name:WOOTEN, WAYNE BROWN (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:BROWN
Last Name:WOOTEN
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 1:6 PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-6912
Mailing Address - Country:US
Mailing Address - Phone:704-633-1528
Mailing Address - Fax:704-633-7097
Practice Address - Street 1:6 PINE TREE RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6912
Practice Address - Country:US
Practice Address - Phone:704-633-1528
Practice Address - Fax:704-633-7097
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC194292085R0202X, 2085N0700X, 2085U0001X, 2085B0100X, 2085R0204X, 2085P0229X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Not Answered2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989244Medicaid
NC213480Medicare ID - Type Unspecified
NCC82399Medicare UPIN