Provider Demographics
NPI:1285010488
Name:WOODMAN, GERALD WAYNE (LVN)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:WAYNE
Last Name:WOODMAN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 W EXPRWY 83
Mailing Address - Street 2:STE #4
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577
Mailing Address - Country:US
Mailing Address - Phone:956-782-5525
Mailing Address - Fax:956-782-5500
Practice Address - Street 1:1210 W EXPRWY 83
Practice Address - Street 2:STE #4
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-782-5525
Practice Address - Fax:956-782-5500
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142877261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care