Provider Demographics
NPI:1225266844
Name:WOODWARD, JENNIFER (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 MONTGOMERY RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2309
Mailing Address - Country:US
Mailing Address - Phone:513-561-7809
Mailing Address - Fax:513-272-4121
Practice Address - Street 1:11140 MONTGOMERY RD STE 2500
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45249-2309
Practice Address - Country:US
Practice Address - Phone:513-561-7809
Practice Address - Fax:513-272-4121
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine