Provider Demographics
NPI:1538148978
Name:WOODEN, PAUL BLAKE (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BLAKE
Last Name:WOODEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:115 MT BLUE CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6239
Mailing Address - Country:US
Mailing Address - Phone:207-778-6800
Mailing Address - Fax:207-778-9800
Practice Address - Street 1:115 MT BLUE CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6239
Practice Address - Country:US
Practice Address - Phone:207-778-6800
Practice Address - Fax:207-778-9800
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2011-12-13
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Provider Licenses
StateLicense IDTaxonomies
ME014165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME335310099Medicaid
ME335310099Medicaid
MEMM6067Medicare PIN