MEDICARE: MS. SUSAN GAIL WOODS MS, RD/LD

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	133V00000X	Registered Dietitian	713	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033211628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN GAIL WOODS MS, RD/LD

Provider Business Mailing Address
First Line	:	2056 WESTBURY DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-8209
Country	:	US
Telephone Number	:	405-550-7985
Fax Number	:	405-769-9247

Provider Business Practice Location Address
First Line	:	2056 WESTBURY DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-8209
Country	:	US
Telephone Number	:	405-550-7985
Fax Number	:	405-769-9247

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	12/03/2009

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