MEDICARE: MR. CHARLES AARON WOODWARD III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1114364759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES AARON WOODWARD III

Provider Business Mailing Address
First Line	:	9914 W MILITARY DR
Second Line	:	APT 412
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-1783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 BERGQUIST DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-9907
Country	:	US
Telephone Number	:	210-292-7797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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