MEDICARE: DR. KELLEY A WOODRUFF M.D.

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	208000000X	Pediatrics Physician	MD8054	HI
2	2080B0002X	Pediatric Obesity Medicine Physician	MD8054	HI
3	2080P0207X	Pediatric Hematology & Oncology Physician	MD8054	HI
4	2080A0000X	Pediatric Adolescent Medicine Physician	MD8054	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	753021507	OTHER	HI	HILB,HMA,HMAA
2	0000D06595	OTHER	HI	HMSA,HMSA QUEST,BCBS
3	MD805403	OTHER	HI	AET,NYLC,PBP,UHC,QHCP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619903416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLEY A WOODRUFF M.D.

Provider Business Mailing Address
First Line	:	9040 JACKSAON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	253-459-5161
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040 JACKSAON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	253-459-5161
Fax Number	:

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/16/2025

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