Provider Demographics
NPI:1144264805
Name:WOFFORD, BERT W (MD)
Entity type:Individual
Prefix:
First Name:BERT
Middle Name:W
Last Name:WOFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:774 STATE HIGHWAY 70 N
Mailing Address - Street 2:
Mailing Address - City:ROTAN
Mailing Address - State:TX
Mailing Address - Zip Code:79546-6918
Mailing Address - Country:US
Mailing Address - Phone:325-735-2211
Mailing Address - Fax:325-735-2240
Practice Address - Street 1:774 STATE HIGHWAY 70 N
Practice Address - Street 2:
Practice Address - City:ROTAN
Practice Address - State:TX
Practice Address - Zip Code:79546-6918
Practice Address - Country:US
Practice Address - Phone:325-735-2211
Practice Address - Fax:325-735-2240
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2004-0074207Q00000X
TXP8002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I28613Medicare UPIN