Healthcare Provider Details

I. General information

NPI: 1932267184
Provider Name (Legal Business Name): JASON RUSSELL WOODWARD MS, MPH, RD, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVE., NW, ATTN MCHL-MAO-C
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

3109 RIVER BEND CT APT D202
LAUREL MD
20724
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-2016
  • Fax:
Mailing address:
  • Phone: 316-214-6195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT06242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: