Provider Demographics
NPI:1316954225
Name:WOODLIFF, DANIEL MORSE (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MORSE
Last Name:WOODLIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:GENERAL INTERNAL MEDICINE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4146
Mailing Address - Country:US
Mailing Address - Phone:601-984-5660
Mailing Address - Fax:601-984-6870
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIVISION OF GENERAL INTERNAL MED
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4620
Practice Address - Country:US
Practice Address - Phone:601-984-5660
Practice Address - Fax:601-984-6870
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS08450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00011097Medicaid
MS110029884OtherRAILROAD MEDICARE
MSP00671039Medicare PIN
MS302I115871Medicare PIN
MS110029884OtherRAILROAD MEDICARE
MSB64140Medicare UPIN
MS110000371Medicare ID - Type Unspecified
MS00011097Medicaid