Basic Information
| Provider Information | |||||||||
| NPI: | 1306891296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODWARD | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9434 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658019434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178858888 | ||||||||
| FaxNumber: | 4178817638 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 S NATIONAL AVE | ||||||||
| Address2: | WEST TOWER, SUITE 900 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178858888 | ||||||||
| FaxNumber: | 4178817638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | C-7554 | AR | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 100758 | MO | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 168118001 | 05 | AR | MEDICAID | 4188130001 | 01 | MO | CIGNA MEDICARE | OTHER | 5421593001 | 01 | MO | CIGNA HEALTHCARE | OTHER | 203420716 | 05 | MO | MEDICAID | 149639 | 01 | MO | BLUE CROSS/CHOICE | OTHER | F10812 | 01 | MO | USPS (W/C) | OTHER | 2086 | 01 | MO | COX HEALTH PLANS UPI | OTHER |