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General NPI Number Information
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NPI Number | 1548243645
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Entity Type | Individual
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Provider Name | KELLY H WOODWARD I D.O., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 5532 LILLEHAMMER LN STE 102
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City | PARK CITY
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State | UT
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Zip | 84098-6078
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Country | US
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Telephone | 435-659-7633
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Fax | 971-397-0394
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Provider Business Mailing Address
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Address Line | 7165 CANYON DR
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City | PARK CITY
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State | UT
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Zip | 84098-5382
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Country | US
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Telephone | 703-907-9716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 9693614-1204
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 9693614-1204
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License Number State | UT
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