NPI Code Detail JSON Logo

1245490812 NPI number — JENNIFER M WOODWARD MD

NPI Number: 1245490812
Health Care Provider/Practitioner: JENNIFER M WOODWARD MD

Information about “1245490812” NPI (JENNIFER M WOODWARD MD) exists in 1245490812 in HTML format HTML  |  1245490812 in plain Text format TXT  |  1245490812 in PDF (Portable Document Format) PDF  |  1245490812 in an XML format XML  formats.

NPI Number : 1245490812 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245490812",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOODWARD",
    "FirstName": "JENNIFER",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FERNANDEZ",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "675 N SAINT CLAIR ST STE 18-200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60611-5929",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-695-4525",
    "MailingAddressFaxNumber": "312-695-6007",
    "FirstLinePracticeLocationAddress": "675 N SAINT CLAIR ST STE 18-200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60611-5929",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-695-4525",
    "PracticeLocationAddressFaxNumber": "312-695-6007",
    "EnumerationDate": "06/16/2008",
    "LastUpdateDate": "12/06/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "2010-00328",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207QG0300X",
          "TaxonomyName": "Geriatric Medicine (Family Medicine) Physician",
          "LicenseNumber": "2010-00328",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RG0300X",
          "TaxonomyName": "Geriatric Medicine (Internal Medicine) Physician",
          "LicenseNumber": "2010-00328",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207QG0300X",
          "TaxonomyName": "Geriatric Medicine (Family Medicine) Physician",
          "LicenseNumber": "036137819",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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