Individual
CHARLES E WOODALL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000
(417) 875-3245
Mailing address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2002024530
MO
2086X0206X
Surgical Oncology Physician
Primary
2002024530
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730279506
—
MO
05
—
209419902
—
MO
Enumeration date
10/13/2006
Last updated
12/27/2018
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