Basic Information
| Provider Information | |||||||||
| NPI: | 1942620604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOLARD | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | MARVIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 19TH ST S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059346007 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 NW 138TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731342513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052424100 | ||||||||
| FaxNumber: | 4057759356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 34555 | OK | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200838900A | 05 | OK | MEDICAID |