Individual
DR. GERALD A WOODWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
301 SCOTT AVE, RUPERT, ID 83350-1800
(208) 436-6406
(208) 436-9678
Mailing address
PO BOX 338, RUPERT, ID 83350-0338
(208) 436-6406
(208) 436-9678
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1363
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010009632
REGENCE BLUESHIELD
ID
01
—
1363
DELTA DENTAL
ID
01
—
560823
UNITED CONCORDIA
—
01
—
6F696
BLUE CROSS OF IDAHO
ID
Enumeration date
07/03/2006
Last updated
07/08/2007
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