Provider Demographics
NPI:1144369984
Name:WOODDELL, WILLIAM JEFF (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JEFF
Last Name:WOODDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 SPRINGDOWNS PLACE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906
Mailing Address - Country:US
Mailing Address - Phone:719-576-1551
Mailing Address - Fax:719-576-3583
Practice Address - Street 1:825 EAST PIKES PEAK AVE
Practice Address - Street 2:SUITE 600 PIKES PEAK HOSPICE
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3624
Practice Address - Country:US
Practice Address - Phone:719-633-3400
Practice Address - Fax:719-633-3800
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24839207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61500Medicare PIN