Individual
ROBERT T WOODBURN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8702 BROADWAY, MERRILLVILLE, IN 46410-7035
(219) 738-5598
Mailing address
8702 BROADWAY, MERRILLVILLE, IN 46410-7035
(219) 738-5598
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01052621A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000251225
ANTHEM
IN
05
—
200310530
—
IN
05
—
307891112
—
IL
01
—
P00051343
RAIL ROAD MEDICARE
IN
01
—
P00368101
RAIL ROAD MEDICARE
IL
Enumeration date
08/22/2005
Last updated
01/06/2022
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