MEDICARE: DI'ARA WOODS PA-C

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	363A00000X	Physician Assistant

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	MO	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1497115497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DI'ARA WOODS PA-C

Provider Business Mailing Address
First Line	:	403 GLEN CARBON RD
Second Line	:
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-2965
Country	:	US
Telephone Number	:	314-749-8906
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 CLUB CENTRE CT STE B1
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-3519
Country	:	US
Telephone Number	:	618-699-4402
Fax Number	:

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

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	04/24/2023

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Directions to “ DI'ARA WOODS PA-C” Practice Location

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