MEDICARE: CRAIG D. WOODARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	ME19338	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	92527	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1033198106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG D. WOODARD MD

Provider Business Mailing Address
First Line	:	PO BOX 452375
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33345-2375
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 NW 170TH ST
Second Line	:	#303
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33169-5513
Country	:	US
Telephone Number	:	305-653-0050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	10/09/2007

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