Provider Demographics
NPI:1023034071
Name:WOODWARD, JOHN BUFORD III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BUFORD
Last Name:WOODWARD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033
Mailing Address - Country:US
Mailing Address - Phone:303-425-6856
Mailing Address - Fax:303-425-1661
Practice Address - Street 1:4045 WADSWORTH BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-425-6856
Practice Address - Fax:303-425-1661
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO211192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01211192Medicaid
CO017607OtherKAISER COMMERCIAL NUMBER
D23883Medicare UPIN
CO01211192Medicaid
COCOAAA1956Medicare PIN