Provider Demographics
NPI:1023009859
Name:WOODS, RANDY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LYNN
Last Name:WOODS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 S HICKMAN ST
Mailing Address - Street 2:
Mailing Address - City:PUXICO
Mailing Address - State:MO
Mailing Address - Zip Code:63960-9122
Mailing Address - Country:US
Mailing Address - Phone:573-222-2292
Mailing Address - Fax:573-222-2383
Practice Address - Street 1:250 S HICKMAN ST
Practice Address - Street 2:
Practice Address - City:PUXICO
Practice Address - State:MO
Practice Address - Zip Code:63960-9122
Practice Address - Country:US
Practice Address - Phone:573-222-2292
Practice Address - Fax:573-222-2383
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMDR1K29208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE48759Medicare UPIN
MO26-3926Medicare ID - Type Unspecified