Provider Demographics
NPI:1053429084
Name:WOODSON, LEE CLINTON (MD, PHD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:CLINTON
Last Name:WOODSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 MARKET ST
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-2725
Mailing Address - Country:US
Mailing Address - Phone:409-770-6607
Mailing Address - Fax:409-770-6919
Practice Address - Street 1:815 MARKET ST
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-2725
Practice Address - Country:US
Practice Address - Phone:409-770-6607
Practice Address - Fax:409-770-6919
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5502207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology