| Bruce A Woodling Md Inc | |
|
148 N Brent St Ste 102 Ventura CA 93003-2825 | |
| (805) 482-6643 | |
| Not Available |
| Full Name | Bruce A Woodling Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 148 N Brent St Ste 102, Ventura, California |
| Authorized Official Name and Position | Bruce A Woodling (PRESIDENT) |
| Authorized Official Contact | 8054826643 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce A Woodling Md Inc Po Box 1088 Ventura CA 93002-1088 Ph: (805) 482-6643 | Bruce A Woodling Md Inc 148 N Brent St Ste 102 Ventura CA 93003-2825 Ph: (805) 482-6643 |
| NPI Number | 1164612776 |
|---|---|
| Provider Enumeration Date | 07/30/2007 |
| Last Update Date | 02/06/2024 |
| Medicare PECOS PAC ID | 2163869728 |
|---|---|
| Medicare Enrollment ID | O20240319002959 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164612776 | NPI | - | NPPES |
| 00G24570 | Medicaid | CA | |
| G24570 | Other | CA | STATE LICENSE |
| 1457433971 | Other | CA | TYPE 1 NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | G24570 (California) | Primary |
| Provider Name | Bruce A Woodling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457433971 PECOS PAC ID: 8123155777 Enrollment ID: I20100429001128 |
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