Basic Information
| Provider Information | |||||||||
| NPI: | 1083616338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOG | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1631 HOSPITAL DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059827246 | ||||||||
| FaxNumber: | 5059834812 | ||||||||
| Practice Location | |||||||||
| Address1: | 1631 HOSPITAL DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059827246 | ||||||||
| FaxNumber: | 5059834812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 11/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 93-434 | NM | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 157943 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 315243 | 05 | AZ | MEDICAID | NM009C94 | 01 | NM | BLUE CROSS BLUE SHIELD | OTHER | 46503242 | 05 | CO | MEDICAID | 7613840 | 05 | NC | MEDICAID | 850210604008 | 05 | UT | MEDICAID | 48105 | 05 | NM | MEDICAID | 28032 | 05 | NM | MEDICAID |