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NPI Code Detail

MEDICARE: DR. GERALD R WOODARD D.O.

MEDICARE: DR. GERALD R WOODARD D.O.
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
1207Q00000XFamily Medicine PhysicianOS4717FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700877388
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GERALD R WOODARD D.O.
Provider Business Mailing Address
First Line : 3512 S ATLANTIC AVE
Second Line :
City : DAYTONA BEACH SHORES
State : FL
Zip : 32118-7639
Country : US
Telephone Number : 386-767-9544
Fax Number : 386-756-0501
Provider Business Practice Location Address
First Line : 3512 S ATLANTIC AVE
Second Line :
City : DAYTONA BEACH SHORES
State : FL
Zip : 32118-7639
Country : US
Telephone Number : 386-767-9544
Fax Number : 386-756-0501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 08/10/2007

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