MEDICARE: DR. JUSTIN TREVOR WOODSON MD

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	2083A0100X	Aerospace Medicine Physician	K5749	TX
2	207UN0902X	Nuclear Imaging & Therapy Physician	K5749	TX
3	2085R0202X	Diagnostic Radiology Physician	0101285718	VA
4	2085R0202X	Diagnostic Radiology Physician	K5749	TX
5	2085R0204X	Vascular & Interventional Radiology Physician	K5749	TX

General Provider Information

NPI Number	:	1720058951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN TREVOR WOODSON MD

Provider Business Mailing Address
First Line	:	301 ANDREWS AVE
Second Line	:
City	:	FORT RUCKER
State	:	AL
Zip	:	36362
Country	:	US
Telephone Number	:	334-255-7387
Fax Number	:	334-255-7716

Provider Business Practice Location Address
First Line	:	WOMACK ARMY MEDICAL CENTER 2817 ROCK MERRITT AVE
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	301-512-0017
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	02/19/2026

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