Healthcare Provider Details

I. General information

NPI: 1285160457
Provider Name (Legal Business Name): TYLER JEFFREY WOODARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S EUCLID AVE STE 905
SAINT LOUIS MO
63110-1005
US

IV. Provider business mailing address

5655 PERSHING AVE APT 304
SAINT LOUIS MO
63112-2143
US

V. Phone/Fax

Practice location:
  • Phone: 314-273-5735
  • Fax:
Mailing address:
  • Phone: 919-671-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number2021010145
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number101118
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2021010145
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: