Basic Information
| Provider Information | |||||||||
| NPI: | 1023308178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODKOTCH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12221 MERIT DR | ||||||||
| Address2: | #1500 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752512202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142171911 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12221 MERIT DR | ||||||||
| Address2: | #1500 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752512202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142171911 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 301405-01 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | Q3313 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 25MA10732600 | NJ | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.