Provider Demographics
NPI:1598107153
Name:JOHN B WOODWARD III MD PC
Entity Type:Organization
Organization Name:JOHN B WOODWARD III MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:303-425-6856
Mailing Address - Street 1:4045 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4642
Mailing Address - Country:US
Mailing Address - Phone:303-425-6856
Mailing Address - Fax:303-425-1661
Practice Address - Street 1:4045 WADSWORTH BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4642
Practice Address - Country:US
Practice Address - Phone:303-425-6856
Practice Address - Fax:303-425-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty