James Donald Woodburn, MD
Individual provider Active NPI Emergency Medicine Physician · Deephaven, MN
NPI 1649264243 · NPPES record last updated Jan 1, 2010
Key facts
- NPI
- 1649264243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 29678 (MN)
- Practice address
- 4210 Chimo East St
Deephaven, MN 55391-3502 - Phone
- (612) 599-6738
- NPI assigned
- Sep 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29678 | MN | MD | Emergency Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 29678 | MN | Yes |
Addresses
Primary practice location
4210 Chimo East St
Deephaven, MN 55391-3502
Mailing address
4210 Chimo East St
Deephaven, MN 55391-3502
Other providers in Deephaven, MN
All providers in Deephaven, MN · Emergency Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 1, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.