MEDICARE: JOHN S WOODYARD PA

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	363AM0700X	Medical Physician Assistant	PA9106127	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA9106127	OTHER	FL	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528349123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN S WOODYARD PA

Provider Business Mailing Address
First Line	:	PO BOX 232
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33526-0232
Country	:	US
Telephone Number	:	352-518-2000
Fax Number	:	352-567-1974

Provider Business Practice Location Address
First Line	:	37944 CHURCH AVE
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-4207
Country	:	US
Telephone Number	:	352-518-2000
Fax Number	:	352-567-1974

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	09/09/2011

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Directions to “ JOHN S WOODYARD PA” Practice Location

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