MEDICARE: THOMAS ALLAN WOODWARD 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	208000000X	Pediatrics Physician	14929	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14929	OTHER	KY	STATE LICENSURE BOARD

General Provider Information

NPI Number	:	1760472658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS ALLAN WOODWARD MD

Provider Business Mailing Address
First Line	:	PO BOX 719
Second Line	:
City	:	BURGIN
State	:	KY
Zip	:	40310-0719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	K142 KENTUCKY CLINIC
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0284
Country	:	US
Telephone Number	:	859-323-3864
Fax Number	:	859-857-2195

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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