MEDICARE: STEPHANIE WOODWARD MD INC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1215663844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE WOODWARD MD INC

Provider Business Mailing Address
First Line	:	1671 W MAIN ST STE A
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-5420
Country	:	US
Telephone Number	:	760-353-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1671 W MAIN ST STE A
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-5420
Country	:	US
Telephone Number	:	760-353-2244
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEPHANIE WOODWARD
Credential	:	MD
Telephone Number	:	702-371-4589

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	07/26/2022

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