Provider Demographics
NPI:1316012230
Name:WOODARD, ROBERT E (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:WOODARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5105 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-7627
Mailing Address - Country:US
Mailing Address - Phone:918-712-9990
Mailing Address - Fax:918-712-9390
Practice Address - Street 1:5105 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-7627
Practice Address - Country:US
Practice Address - Phone:918-712-9990
Practice Address - Fax:918-712-9390
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKA251231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS731528411Medicaid
OK5655639Medicare UPIN