Healthcare Provider Details

I. General information

NPI: 1962444364
Provider Name (Legal Business Name): MARIANNA BOAZ WOODWARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NOBLE ST
FAIRBANKS AK
99701-4922
US

IV. Provider business mailing address

1001 NOBLE ST
FAIRBANKS AK
99701-4922
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3520
  • Fax: 907-459-3554
Mailing address:
  • Phone: 907-459-3500
  • Fax: 907-459-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2657
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: