Basic Information
| Provider Information | |||||||||
| NPI: | 1225117559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODALL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LIAM | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2151 OLD ROCKY RIDGE RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA HILLS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352167251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059891080 | ||||||||
| FaxNumber: | 2059891087 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 BROOKWOOD MEDICAL CTR DR | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058771000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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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 | 367500000X | 1-084644 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.