MEDICARE: HALBERT OWEN WOODWARD JR. MD

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	208000000X	Pediatrics Physician	E1189	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0084GS	OTHER	BCBS GROUP
2	118823	OTHER	SUPERIOR
3	8B8061	OTHER	BCBS DR
4	2323763	OTHER	BLUE LINK
5	44163	OTHER	AMERIGROUP

General Provider Information

NPI Number	:	1780796656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALBERT OWEN WOODWARD JR. MD

Provider Business Mailing Address
First Line	:	2500 CROCKETT DRIVE
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5900
Country	:	US
Telephone Number	:	325-643-5456
Fax Number	:	325-643-9590

Provider Business Practice Location Address
First Line	:	2500 CROCKETT DRIVE
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5900
Country	:	US
Telephone Number	:	325-643-5456
Fax Number	:	325-643-9590

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/07/2023

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Directions to “ HALBERT OWEN WOODWARD JR. MD” Practice Location

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