Individual
THOMAS D WOOLDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1542 MEDICAL PARK CIR, TUPELO, MS 38801-6560
(662) 844-4711
(662) 844-9619
Mailing address
1542 MEDICAL PARK CIR, TUPELO, MS 38801-6560
(662) 844-4711
(662) 844-9619
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
6480
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00016236
—
MS
01
—
0010676
BLUE CROSS BLUE SHIELD
MS
05
—
008604410
—
AL
01
—
390001766
RAILROAD MEDICARE PIN
GA
01
—
6480
STATE LICENSED NUMBER
MS
01
—
73003901
BLUE CROSS PIN
—
Enumeration date
01/26/2006
Last updated
08/13/2010
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