Healthcare Provider Details

I. General information

NPI: 1336601830
Provider Name (Legal Business Name): H RANDAL WOODWARD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 N 72ND ST
OMAHA NE
68122-1746
US

IV. Provider business mailing address

1758 S 105TH ST
OMAHA NE
68124-1015
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-2211
  • Fax:
Mailing address:
  • Phone: 402-680-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: HOWARD R WOODWARD
Title or Position: PRESIDENT
Credential: MD
Phone: 402-680-9581