Provider Demographics
NPI:1982121356
Name:WOODALL, LINDA LEE (RT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:WOODALL
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT
Mailing Address - Street 1:12423 DRYSDALE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-4200
Mailing Address - Country:US
Mailing Address - Phone:352-428-0164
Mailing Address - Fax:
Practice Address - Street 1:20158 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3832
Practice Address - Country:US
Practice Address - Phone:352-544-2333
Practice Address - Fax:352-544-2303
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT165872085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16587OtherDEPARTMENT OF HEALTH