Provider Demographics
NPI:1063931277
Name:WOOTEN, ROBERT (HIS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CRESTLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6816
Mailing Address - Country:US
Mailing Address - Phone:252-903-3707
Mailing Address - Fax:
Practice Address - Street 1:1825 W CITY DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9675
Practice Address - Country:US
Practice Address - Phone:252-338-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist