Provider Demographics
NPI:1598969388
Name:WOODRUFF, STACEY LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNNE
Last Name:WOODRUFF
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 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-526-2477
Mailing Address - Fax:808-528-3671
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 703
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-526-2477
Practice Address - Fax:808-528-3671
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-17258208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD-17258OtherHAWAII MEDICAL LICENSE
TXM9748OtherTEXAS MEDICAL LICENSE