Individual
DR. BRENT GRAY WOODBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
Mailing address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
39649
IA
207X00000X
Orthopaedic Surgery Physician
94-06593
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558412130
WELLMARK BLUE CROSS BLUE SHIELD
IA
05
—
1558412130
—
IA
Enumeration date
01/12/2007
Last updated
10/06/2011
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