Healthcare Provider Details

I. General information

NPI: 1184988644
Provider Name (Legal Business Name): RYAN SCOTT WOODMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W COVELL BLVD
DAVIS CA
95616-5645
US

IV. Provider business mailing address

2660 W COVELL BLVD
DAVIS CA
95616-5645
US

V. Phone/Fax

Practice location:
  • Phone: 530-747-3000
  • Fax:
Mailing address:
  • Phone: 530-747-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number20A16863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: