Individual
BRIAN DOUGLAS WOOTON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
40520 CO HWY 34, WHITE EARTH HEALTH CENTER, OGEMA, MN 56569
(218) 983-4300
(218) 983-6217
Mailing address
801 SOUTH DR, FARGO, ND 58103
(701) 235-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47147
MN
207Q00000X
Family Medicine Physician
8642
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
351G7W0
BCBS
—
01
—
585241027376
PREFERRED ONE
—
Enumeration date
04/26/2006
Last updated
07/08/2007
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