MEDICARE: WOODBURY OBSTETRICS & GYNECOLOGY

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	207V00000X	Obstetrics & Gynecology Physician		MN
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	183R5W0	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1215017405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODBURY OBSTETRICS & GYNECOLOGY

Provider Business Mailing Address
First Line	:	8360 CITY CENTRE DR
Second Line	:	SUITE 120
City	:	WOODBURY
State	:	MN
Zip	:	55125-3381
Country	:	US
Telephone Number	:	631-739-2182
Fax Number	:	651-739-2045

Provider Business Practice Location Address
First Line	:	8360 CITY CENTRE DR
Second Line	:	SUITE 120
City	:	WOODBURY
State	:	MN
Zip	:	55125-3381
Country	:	US
Telephone Number	:	651-739-2182
Fax Number	:	651-739-2045

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERALD BARNARD
Credential	:	MD
Telephone Number	:	651-739-1848

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	03/19/2008

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