Provider Demographics
NPI:1174599989
Name:WOODSON, RONALD COLE (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:COLE
Last Name:WOODSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4105
Mailing Address - Country:US
Mailing Address - Phone:361-991-4007
Mailing Address - Fax:361-991-2074
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4105
Practice Address - Country:US
Practice Address - Phone:361-991-4007
Practice Address - Fax:361-991-2074
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0806234-01Medicaid
TX0806234-01Medicaid
TXB27667Medicare UPIN