Provider Demographics
NPI:1487638086
Name:WOODMAN, TROY JAMES (MD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:JAMES
Last Name:WOODMAN
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 1:2202 S CEDAR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2318
Mailing Address - Country:US
Mailing Address - Phone:253-627-2900
Mailing Address - Fax:253-627-2941
Practice Address - Street 1:2202 S CEDAR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2318
Practice Address - Country:US
Practice Address - Phone:253-627-2900
Practice Address - Fax:253-627-2941
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000382392082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA155728OtherDEPT OF LABOR & INDUSTRY
WA8251027Medicaid
WAGAB25811Medicare PIN
WA155728OtherDEPT OF LABOR & INDUSTRY
WAG98151Medicare UPIN