Healthcare Provider Details

I. General information

NPI: 1730168196
Provider Name (Legal Business Name): STEVEN D WOODWARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BAY AVE
RICHTON MS
39476-9665
US

IV. Provider business mailing address

400 HOSPITAL RD
STARKVILLE MS
39759-2163
US

V. Phone/Fax

Practice location:
  • Phone: 601-788-9222
  • Fax: 601-788-2223
Mailing address:
  • Phone: 662-615-2503
  • Fax: 662-615-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16235
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: