MEDICARE: JOHN D. WOODY, MD, PA

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	207LP2900X	Pain Medicine (Anesthesiology) Physician		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DD6609	OTHER	FL	RAILROAD MEDICARE

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
2	38562	OTHER	FL	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063465524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D. WOODY, MD, PA

Provider Business Mailing Address
First Line	:	PO BOX 863258
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-3258
Country	:	US
Telephone Number	:	855-496-3581
Fax Number	:	844-876-0873

Provider Business Practice Location Address
First Line	:	3340 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-1974
Country	:	US
Telephone Number	:	317-614-9863
Fax Number	:	844-876-0873

Authorized Official
Title or Position	:	MD/PRESIDENT
Name	:	DR. JOHN WOODY
Credential	:	MD
Telephone Number	:	317-614-9863

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	10/26/2018

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