Provider Demographics
NPI:1548243645
Name:WOODWARD, KELLY H I (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:H
Last Name:WOODWARD
Suffix:I
Gender:M
Credentials:DO, MPH
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Mailing Address - Street 1:900 ROUND VALLEY DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7552
Mailing Address - Country:US
Mailing Address - Phone:435-658-7882
Mailing Address - Fax:435-333-3536
Practice Address - Street 1:900 ROUND VALLEY DR
Practice Address - Street 2:SUITE 250
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7552
Practice Address - Country:US
Practice Address - Phone:435-658-7882
Practice Address - Fax:435-333-3536
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-08-12
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Provider Licenses
StateLicense IDTaxonomies
UT9693614-12042083P0901X, 207Q00000X
VA0102201996207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine