Provider Demographics
NPI:1750366761
Name:WOOTTON, FRANK TAYLOR III (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:TAYLOR
Last Name:WOOTTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:WOOTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-466-0165
Mailing Address - Fax:757-466-7296
Practice Address - Street 1:885 KEMPSVILLE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-466-0165
Practice Address - Fax:757-466-7296
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047624207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA15933OtherOPTIMA
VA541870984-006OtherCIGNA
VA5807743Medicaid
VA323629OtherANTHEM BCBS
VA4223636OtherAETNA
VA1659563799OtherGROUP NPI
NC890543TMedicaid
VA1659563799OtherGROUP NPI