Provider Demographics
NPI:1922205186
Name:WOODRUFF, DANIEL YOUNG (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:YOUNG
Last Name:WOODRUFF
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 1:2444 W. LAS PALMARITAS DR.
Mailing Address - Street 2:MAIL STOP A 112
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4883
Mailing Address - Country:US
Mailing Address - Phone:602-864-2160
Mailing Address - Fax:602-864-5855
Practice Address - Street 1:2444 W. LAS PALMARITAS DR
Practice Address - Street 2:MAIL STOP A 112
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:602-864-2160
Practice Address - Fax:602-864-5855
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201200193208800000X
KS6848208800000X
AZ50653208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ029735Medicaid
NC1724TOtherBCBS
NC7598AMedicare PIN
AZ029735Medicaid