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General NPI Number Information
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NPI Number | 1528266392
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Entity Type | Organization
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Legal Business Name | LAWRENCE LEONARD WOODS
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 107 SW 1ST ST SUITE 104
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City | ENTERPRISE
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State | OR
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Zip | 97828-1201
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Country | US
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Telephone | 541-426-6070
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Fax | 541-426-6079
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Provider Business Mailing Address
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Address Line | 107 SW 1ST ST SUITE 104
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City | ENTERPRISE
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State | OR
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Zip | 97828-1201
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Country | US
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Telephone | 541-426-6070
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Fax | 541-426-6079
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Authorized Official
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Title or Position | SOLE PRACTITIONER
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Name | LAWRENCE LEONARD WOODS
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Credential | M.D.
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Telephone | 541-426-6070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD15448
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License Number State | OR
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