Healthcare Provider Details

I. General information

NPI: 1457352452
Provider Name (Legal Business Name): WILLARD M WOODS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 BRICE ST
WHEATLAND WY
82201-3505
US

IV. Provider business mailing address

1551 BRICE ST
WHEATLAND WY
82201-3505
US

V. Phone/Fax

Practice location:
  • Phone: 307-322-3861
  • Fax: 307-322-2018
Mailing address:
  • Phone: 307-322-3861
  • Fax: 307-322-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2725A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: