Provider Demographics
NPI:1255314829
Name:WOODS, GEORGE RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RONALD
Last Name:WOODS
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 1:101 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8309
Mailing Address - Country:US
Mailing Address - Phone:318-387-5244
Mailing Address - Fax:
Practice Address - Street 1:101 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-8309
Practice Address - Country:US
Practice Address - Phone:318-387-5244
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5J619Medicare ID - Type Unspecified
LA1107646Medicare ID - Type Unspecified
LAC67239Medicare UPIN