Healthcare Provider Details

I. General information

NPI: 1275577017
Provider Name (Legal Business Name): DREW WOODWARD, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S PARK ST
CASPER WY
82601-2836
US

IV. Provider business mailing address

304 S PARK ST
CASPER WY
82601-2836
US

V. Phone/Fax

Practice location:
  • Phone: 307-237-5478
  • Fax: 307-237-5575
Mailing address:
  • Phone: 307-237-5478
  • Fax: 307-237-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5447A
License Number StateWY

VIII. Authorized Official

Name: DREW WOODWARD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-237-5478