Individual
MARK DOUGLAS WOFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8230 SUMMA AVE STE C, BATON ROUGE, LA 70809-3465
(225) 757-0552
(225) 763-9997
Mailing address
8230 SUMMA AVE STE C, BATON ROUGE, LA 70809-3465
(225) 757-0552
(225) 763-9997
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
12503R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1493481
—
LA
01
—
5H747
MEDICARE
LA
Enumeration date
01/18/2006
Last updated
01/11/2015
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