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Individual

ROBERT ORLO WOODBURY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1701 4TH ST, STE 200, SANTA ROSA, CA 95404-3601
(707) 579-2100
(707) 523-0616
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 525-6485
(707) 523-0616

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G77680
CA
2086S0127X
Trauma Surgery Physician
G77680
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00G776800
BLUE SHIELD OF CALIFORNIA
CA
05
1871607937
CA
01
P00469237
RAILROAD MEDICARE
CA
Enumeration date
08/18/2006
Last updated
02/07/2012
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