Healthcare Provider Details

I. General information

NPI: 1982725727
Provider Name (Legal Business Name): MARK DOWNING WOODARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 BISHOP RANDALL DR
LANDER WY
82520-3939
US

IV. Provider business mailing address

27 GANNETT PEAK DR
LANDER WY
82520-9643
US

V. Phone/Fax

Practice location:
  • Phone: 307-335-6352
  • Fax:
Mailing address:
  • Phone: 307-332-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number5662A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: