Provider Demographics
NPI:1336123363
Name:WOODWARD, PHILIP ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ARTHUR
Last Name:WOODWARD
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 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-623-8110
Mailing Address - Fax:501-623-2296
Practice Address - Street 1:1662 HIGDON FERRY RD
Practice Address - Street 2:SUITE 140
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6999
Practice Address - Country:US
Practice Address - Phone:501-623-8110
Practice Address - Fax:501-623-2296
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2776208800000X
IA18952208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102408001Medicaid
ARD05025Medicare PIN
AR55826Medicare ID - Type Unspecified
AR340013395OtherRAILROAD MEDICARE
AR55826OtherARK BLUE CROSS BLUE SHIEL
ARD05025Medicare UPIN
AR102408001Medicaid
AR340013395OtherRRMCR
AR13263000000OtherQUALCHOICE OF ARKANSAS
AR19-20046OtherUNITED HEALTHCARE
ARAW8741767OtherDEA NUMBER