Healthcare Provider Details

I. General information

NPI: 1184743163
Provider Name (Legal Business Name): TRACI D. WOODARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 NORTH BLVD
BATON ROUGE LA
70806-3825
US

IV. Provider business mailing address

8008 BLUEBONNET BLVD APT. 12-5
BATON ROUGE LA
70810-7800
US

V. Phone/Fax

Practice location:
  • Phone: 225-655-6422
  • Fax: 225-341-5903
Mailing address:
  • Phone: 225-247-9759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.025775
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: