Provider Demographics
NPI:1679776942
Name:WOODUS, TIFFANY NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
Last Name:WOODUS
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 1:918 E PLEASANT RUN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1805
Mailing Address - Country:US
Mailing Address - Phone:469-206-9080
Mailing Address - Fax:469-206-9081
Practice Address - Street 1:918 E PLEASANT RUN RD STE 110
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1805
Practice Address - Country:US
Practice Address - Phone:469-206-9080
Practice Address - Fax:469-206-9081
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4951207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN4951OtherTEXAS MEDICAL LICENSE