Healthcare Provider Details

I. General information

NPI: 1114020021
Provider Name (Legal Business Name): DANIEL PAUL WOYDICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CONLEY LAKE RD
DEER LODGE MT
59722-8708
US

IV. Provider business mailing address

400 CONLEY LAKE RD
DEER LODGE MT
59722-8708
US

V. Phone/Fax

Practice location:
  • Phone: 406-415-6522
  • Fax:
Mailing address:
  • Phone: 406-415-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49078
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: