Healthcare Provider Details

I. General information

NPI: 1538087507
Provider Name (Legal Business Name): JON PAUL WOODS II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8109 W KELSEY ST
SIOUX FALLS SD
57106-8416
US

IV. Provider business mailing address

8109 W KELSEY ST
SIOUX FALLS SD
57106-8416
US

V. Phone/Fax

Practice location:
  • Phone: 906-369-7006
  • Fax:
Mailing address:
  • Phone: 906-369-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: