Healthcare Provider Details

I. General information

NPI: 1831771591
Provider Name (Legal Business Name): ROBERT STEVEN WOODS SOIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 EVERETT PARK TRL
HOLLY RIDGE NC
28445-2300
US

IV. Provider business mailing address

107 EVERETT PARK TRL
HOLLY RIDGE NC
28445-2300
US

V. Phone/Fax

Practice location:
  • Phone: 914-424-5552
  • Fax:
Mailing address:
  • Phone: 914-424-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: