Doctor Name: | MR. MARIO WOODEN |
NPI Number: | 1306222674 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 2336 Meverett Cv Cordova, TN - 380162341 |
Business Phone Number: | 9012589815 |
Business Fax Number: | |
Mailing Address: | 2336 Meverett Cv, CORDOVA |
State: | TN |
Postal Code: | 380162341 |
Phone Number: | 9012589815 |
Fax Number: | |
NPI Enumeration Date: | 08/10/2015 |
NPI Last Update Date: | 08/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 172A00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Driver |
Taxonomy Specialization: | |
Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |