Basic Information
| Provider Information | |||||||||
| NPI: | 1184665333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOO | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 557 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802910557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034674155 | ||||||||
| FaxNumber: | 3034674156 | ||||||||
| Practice Location | |||||||||
| Address1: | 3655 LUTHERAN PKWY | ||||||||
| Address2: | #105 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034252631 | ||||||||
| FaxNumber: | 3034678789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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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 | 2083X0100X | 28288 | CO | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01213164 | 05 | CO | MEDICAID |