Healthcare Provider Details

I. General information

NPI: 1952470965
Provider Name (Legal Business Name): JUSTIN WOODS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19801 N 59TH AVE 10550
GLENDALE AZ
85308-9309
US

IV. Provider business mailing address

19801 N 59TH AVE 10550
GLENDALE AZ
85308-9309
US

V. Phone/Fax

Practice location:
  • Phone: 262-383-5517
  • Fax:
Mailing address:
  • Phone: 262-383-5517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62774
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: