Individual
DR. MICHAEL B. WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2115 S FREMONT AVE, SUITE 3300, SPRINGFIELD, MO 65804-2239
(417) 820-5200
(417) 820-5220
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
R8483
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81381
AR BLUE SHIELD #
MO
Enumeration date
02/21/2007
Last updated
07/09/2007
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