Provider Demographics
NPI:1487842654
Name:WOODSON, JENNIFER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:WOODSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1224 10TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3416
Mailing Address - Country:US
Mailing Address - Phone:619-435-2234
Mailing Address - Fax:619-435-1784
Practice Address - Street 1:1224 10TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3416
Practice Address - Country:US
Practice Address - Phone:619-435-2234
Practice Address - Fax:619-435-1784
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2012-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG77861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine