Individual
GARY GENE WOFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 N GRAND AVE, #230, PUEBLO, CO 81003-2700
(719) 562-1000
(719) 562-1827
Mailing address
1600 N GRAND AVE, #230, PUEBLO, CO 81003-2700
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
30398
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0130398
—
CO
Enumeration date
10/10/2006
Last updated
03/07/2023
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