Healthcare Provider Details

I. General information

NPI: 1326174616
Provider Name (Legal Business Name): RACHEL JORDAN WOODS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E 12450 S #100
DRAPER UT
84020-8058
US

IV. Provider business mailing address

1375 BRYAN AVE
SALT LAKE CITY UT
84105-2649
US

V. Phone/Fax

Practice location:
  • Phone: 801-523-3001
  • Fax:
Mailing address:
  • Phone: 801-467-7927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57666831205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: