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Individual
TIMOTHY J WOODVILLE
Active
Individual
TIMOTHY J WOODVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GXC000780
—
CA
Enumeration date
06/09/2005
Last updated
11/18/2008
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