Provider Demographics
NPI:1316023211
Name:WOODHAM, RYAN MAX (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MAX
Last Name:WOODHAM
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:PO BOX 731956
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1956
Mailing Address - Country:US
Mailing Address - Phone:972-475-7500
Mailing Address - Fax:214-427-8650
Practice Address - Street 1:7801 LAKEVIEW PKWY
Practice Address - Street 2:STE 100
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4247
Practice Address - Country:US
Practice Address - Phone:972-475-7500
Practice Address - Fax:214-427-8650
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7765207RC0000X
AL00026447207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00026447Medicare ID - Type UnspecifiedLISCENSE