Healthcare Provider Details

I. General information

NPI: 1033198106
Provider Name (Legal Business Name): CRAIG D. WOODARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 170TH ST #303
NORTH MIAMI BEACH FL
33169-5513
US

IV. Provider business mailing address

PO BOX 452375
SUNRISE FL
33345-2375
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-0050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME19338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: