Healthcare Provider Details

I. General information

NPI: 1306929633
Provider Name (Legal Business Name): RODERICK WOODS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 CHRISTOPHER DR
BELEN NM
87002-2617
US

IV. Provider business mailing address

711 CHRISTOPHER DR
BELEN NM
87002-2617
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-1800
  • Fax: 505-248-1917
Mailing address:
  • Phone: 505-248-1800
  • Fax: 505-248-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2010-0663
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: