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Jack Woodworth Sample

NPI Registration Record

Provider / OrganizationNPIDate Certified
JACK WOODWORTH SAMPLE10933939442021-04-03

Jack Woodworth Sample is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1093393944. Registration indicates Jack Woodworth Sample is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)

Entity TypeIndividual
Provider Name Jack Woodworth Sample Ii MD
Practice Office Address200 1ST ST SW
ROCHESTER, MN US
Practice Office Telephone5072842511
Mailing Address200 1ST ST SW
ROCHESTER, MN 559050001 US
Business Telephone5072842511
HPT Codes
CodePractice
License No
State
390200000X PRIMARY
Student, Health Care
Student in an Organized Health Care Education/Training Program
Student in an Organized Health Care Education/Training Program

All Other Specialties & Provider Types

Student in an Organized Health Care Education/Training Program
Student, Health Care
OPI Codes

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