Dale A Wooten Jr., CCP

Primary specialty

PerfusionistTaxonomy code 242T00000X

Practice address

312 E Houston St
Tyler, TX 75702-8218

Phone

(480) 777-0607

Fax

(480) 777-1345

NPI assigned

Oct 17, 2011

Last updated

Oct 17, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Circulatory Dynamics, Inc.

  • Perfusionist
  • Tyler, TX
  • NPI 1003042458
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1043595465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27664",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852857664",
            "telephone_number": "480-777-0607",
            "fax_number": "480-777-1345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 E HOUSTON ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028218",
            "telephone_number": "480-777-0607",
            "fax_number": "480-777-1345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOTEN",
        "first_name": "DALE",
        "middle_name": "A",
        "name_suffix": "Jr.",
        "credential": "CCP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-17",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "242T00000X",
            "taxonomy_group": "",
            "desc": "Perfusionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Woody Weaver Pharmacy Inc (Woody Weaver Pharmacy)
• Summer N Woody
• Layton Montgomery Woolford, DO
• Julie Ann Woolverton, PT, DPT
• Cody Brandon Wooster, RN
• Lakimberely Shajuan Wooten, APRN
• Maria De Jesus Wooten
• Marcus William Worden, DDS
• Sydney Worth
• James E Wortham, P.A.

• Perfusionist in Tyler, TX
• Providers in Tyler, TX by specialty
• Perfusionist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.