Provider Demographics
NPI:1609843259
Name:WOODARD, RONALD DUAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DUAYNE
Last Name:WOODARD
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 1:1809 VERDUGO BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1476
Mailing Address - Country:US
Mailing Address - Phone:818-790-8121
Mailing Address - Fax:
Practice Address - Street 1:1809 VERDUGO BLVD STE 350
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1476
Practice Address - Country:US
Practice Address - Phone:818-790-8121
Practice Address - Fax:818-952-0926
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG051835207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52096Medicare UPIN