Basic Information
| Provider Information | |||||||||
| NPI: | 1225197999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOFTER | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | LEO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 E PLUM ST | ||||||||
| Address2: | |||||||||
| City: | COLBY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677013423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856753018 | ||||||||
| FaxNumber: | 7856752306 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 S RANGE AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | COLBY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677013537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854623332 | ||||||||
| FaxNumber: | 7854623337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 06/12/2014 | ||||||||
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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 | 363AM0700X | 15-00765 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.