Provider Demographics
NPI:1407342942
Name:WOODLEY, LUCILLE E (MD)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:E
Last Name:WOODLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 OAKLEY SEAVER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1925
Mailing Address - Country:US
Mailing Address - Phone:407-521-3600
Mailing Address - Fax:407-521-3603
Practice Address - Street 1:1919 E HWY 50 STE 201
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1975
Practice Address - Country:US
Practice Address - Phone:352-243-2622
Practice Address - Fax:352-243-6277
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME164175208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119368200Medicaid
1407342942OtherNPI
FL4O124OtherBCBS