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NPI Code Detail

MEDICARE: GERALD R WOODARD DO PA

MEDICARE: GERALD R WOODARD DO 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
1332900000XNon-Pharmacy Dispensing SiteOS4717FL

General Provider Information

NPI Number : 1497166417
Entity Type Code : Organization
Provider Name (Legal Business Name) : GERALD R WOODARD DO PA
Provider Business Mailing Address
First Line : 5626 OBERLIN DR
Second Line : SUITE 110
City : SAN DIEGO
State : CA
Zip : 92121-1705
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3512 S ATLANTIC AVE
Second Line :
City : DAYTONA BEACH SHORES
State : FL
Zip : 32118-7639
Country : US
Telephone Number : 386-767-9544
Fax Number :
Authorized Official
Title or Position : VP OF OPERATIONS
Name : KENNY HEINE
Credential :
Telephone Number : 858-964-1506
Provider Enumeration Date : 05/13/2014
Last Update Date : 05/13/2014

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Directions to “GERALD R WOODARD DO PA ” Practice Location

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