Provider Demographics
NPI:1225117559
Name:WOODALL, ROBERT LIAM (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LIAM
Last Name:WOODALL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 OLD ROCKY RIDGE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-7251
Mailing Address - Country:US
Mailing Address - Phone:205-989-1080
Mailing Address - Fax:205-989-1087
Practice Address - Street 1:2010 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6804
Practice Address - Country:US
Practice Address - Phone:205-877-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084644367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered