Individual
DALE A WOOTEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCP
Contact information
Practice address
312 E HOUSTON ST, TYLER, TX 75702-8218
(480) 777-0607
(480) 777-1345
Mailing address
PO BOX 27664, TEMPE, AZ 85285-7664
(480) 777-0607
(480) 777-1345
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
—
—
Other
Enumeration date
10/17/2011
Last updated
10/17/2011
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