Provider Demographics
NPI:1184981847
Name:WOODALL, ANTHONY K (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:K
Last Name:WOODALL
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 1:707 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4315
Mailing Address - Country:US
Mailing Address - Phone:501-413-8879
Mailing Address - Fax:
Practice Address - Street 1:1431 STARFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-9252
Practice Address - Country:US
Practice Address - Phone:501-413-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA304949207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine