MEDICARE: DR. TERRI LYNN WOODARD M.D.

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	4301087148	MI
2	207VE0102X	Reproductive Endocrinology Physician	P4530	TX

General Provider Information

NPI Number	:	1992759013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRI LYNN WOODARD M.D.

Provider Business Mailing Address
First Line	:	3750 WOODWARD AVE
Second Line	:	STE 200B
City	:	DETROIT
State	:	MI
Zip	:	48201-2007
Country	:	US
Telephone Number	:	313-993-4538
Fax Number	:	313-993-4537

Provider Business Practice Location Address
First Line	:	6651 MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2351
Country	:	US
Telephone Number	:	832-826-7272
Fax Number	:

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/23/2022

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