Provider Demographics
NPI:1750377347
Name:WOODRUFF, ALEXIS CRANE (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:CRANE
Last Name:WOODRUFF
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 1:5734 COVENTRY LANE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7141
Mailing Address - Country:US
Mailing Address - Phone:260-436-7875
Mailing Address - Fax:
Practice Address - Street 1:5734 COVENTRY LANE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:45804-7141
Practice Address - Country:US
Practice Address - Phone:260-436-7875
Practice Address - Fax:260-432-9812
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35717207L00000X, 207LP2900X
IN01062207207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64024441Medicaid
F93308Medicare UPIN
KY0910507Medicare ID - Type Unspecified