Healthcare Provider Details

I. General information

NPI: 1336109123
Provider Name (Legal Business Name): BETH ANN WOODS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH ANN MEDFORD MD

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 S WEBSTER AVE
GREEN BAY WI
54301-2253
US

IV. Provider business mailing address

PO BOX 19070
GREEN BAY WI
54307-9070
US

V. Phone/Fax

Practice location:
  • Phone: 920-496-4700
  • Fax:
Mailing address:
  • Phone: 920-496-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5948
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54516
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number105628
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number62010
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: