Provider Demographics
NPI:1215931951
Name:WOODRUFF, LEE PAUL (DPM)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:PAUL
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 EXECUTIVE SQ
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6086
Mailing Address - Country:US
Mailing Address - Phone:870-933-0041
Mailing Address - Fax:870-933-0531
Practice Address - Street 1:1815 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6086
Practice Address - Country:US
Practice Address - Phone:870-933-0041
Practice Address - Fax:870-933-0531
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR117213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART93025Medicare UPIN
AR56210Medicare ID - Type Unspecified