Basic Information
| Provider Information | |||||||||
| NPI: | 1548255854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODARD | ||||||||
| FirstName: | TORY | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 MDG/SGHJ | ||||||||
| Address2: | 4881 SUGAR MAPLE DR. | ||||||||
| City: | WPAFB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372578349 | ||||||||
| FaxNumber: | 9376561347 | ||||||||
| Practice Location | |||||||||
| Address1: | 88TH MDG | ||||||||
| Address2: | 4881 SUGAR MAPLE DRIVE | ||||||||
| City: | WPAFB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372578349 | ||||||||
| FaxNumber: | 9376561347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 04/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101234528 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 2083A0100X | 0101234528 | VA | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine |
No ID Information.