Healthcare Provider Details

I. General information

NPI: 1942255690
Provider Name (Legal Business Name): ROBERT D WOODS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 FOUNTAIN CT STE 120
LEXINGTON KY
40509-1888
US

IV. Provider business mailing address

320 FOUNTAIN CT SUITE 120
LEXINGTON KY
40509-1896
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-4838
  • Fax: 859-276-4638
Mailing address:
  • Phone: 859-276-4838
  • Fax: 859-276-4638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number20654
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: