Provider Demographics
NPI:1235209669
Name:WOODY, JAY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ROBERT
Last Name:WOODY
Suffix:
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 1:5700 GRANITE PKWY STE 455
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6631
Mailing Address - Country:US
Mailing Address - Phone:469-399-5002
Mailing Address - Fax:
Practice Address - Street 1:5700 GRANITE PKWY STE 455
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6631
Practice Address - Country:US
Practice Address - Phone:469-399-5002
Practice Address - Fax:469-399-5029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-14657207P00000X
TXK7952207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045061114Medicaid
TXG97512Medicare UPIN
TX8F22607Medicare PIN