=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982725727
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK DOWNING WOODARD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 10/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1320 BISHOP RANDALL DR
-----------------------------------------------------
City | LANDER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82520-3939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-335-6352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 GANNETT PEAK DR
-----------------------------------------------------
City | LANDER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82520-9643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-332-3415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0105X
-----------------------------------------------------
Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
-----------------------------------------------------
License Number | 5662A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------