Provider Demographics
NPI:1033311469
Name:WOODY, TAD JAMES
Entity Type:Individual
Prefix:MR
First Name:TAD
Middle Name:JAMES
Last Name:WOODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11867
Mailing Address - Street 2:CORRECTIONAL HEALTH SERVICES
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3229
Mailing Address - Fax:559-445-2772
Practice Address - Street 1:1225 M ST
Practice Address - Street 2:CORRECTIONAL HEALTH, 2ND FLOOR
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1805
Practice Address - Country:US
Practice Address - Phone:559-442-2404
Practice Address - Fax:559-442-5277
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse