Active NPI
Gary Gene Wofford, M.D.
- Exclusive Provider Organization
- Pueblo, CO
National Provider Identifier
1063500544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exclusive Provider Organization
- License
- 30398
- Practice address
- 1600 N Grand Ave
#230
Pueblo, CO 81003-2700 - Phone
- (719) 562-1000
- Fax
- (719) 562-1827
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Exclusive Provider Organization | 302F00000X | 30398 | CO | Primary |
Addresses
Primary practice location
1600 N Grand Ave
#230
Pueblo, CO 81003-2700
Mailing address
1600 N Grand Ave
#230
Pueblo, CO 81003-2700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0130398 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30398 | CO | MD | Exclusive Provider Organization |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1063500544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 N GRAND AVE",
"address_2": "#230",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810032700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 N GRAND AVE",
"address_2": "#230",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810032700",
"telephone_number": "719-562-1000",
"fax_number": "719-562-1827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOFFORD",
"first_name": "GARY",
"middle_name": "GENE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "302F00000X",
"taxonomy_group": "",
"desc": "Exclusive Provider Organization",
"state": "CO",
"license": "30398",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0130398",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.