Healthcare Provider Details

I. General information

NPI: 1285788208
Provider Name (Legal Business Name): DORIAN S WOODS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1684 BUSH LN
CRAWFORDSVILLE IN
47933
US

IV. Provider business mailing address

1684 BUSH LN
CRAWFORDSVILLE IN
47933-3364
US

V. Phone/Fax

Practice location:
  • Phone: 765-365-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01055112A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036088844
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01055112A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: