Individual
EDWARD WRENN WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3344 N FUTRALL DR, FAYETTEVILLE, AR 72703-4057
(479) 443-5316
Mailing address
PO BOX 1523, FAYETTEVILLE, AR 72702-1523
(479) 571-6038
(479) 582-0222
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E3681
AR
2085R0202X
Diagnostic Radiology Physician
L4179
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149763001
—
AR
01
—
8K6572
MEDICARE PTAN
TX
Enumeration date
10/03/2005
Last updated
08/19/2024
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