Healthcare Provider Details

I. General information

NPI: 1487601217
Provider Name (Legal Business Name): JAMES RICHARD WOODY II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 HOSPITAL ST
MONTICELLO KY
42633-2416
US

IV. Provider business mailing address

166 HOSPITAL ST
MONTICELLO KY
42633-2430
US

V. Phone/Fax

Practice location:
  • Phone: 606-348-9343
  • Fax: 865-291-3228
Mailing address:
  • Phone: 606-348-9343
  • Fax: 606-340-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number33157
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33157
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: