Provider Demographics
NPI:1770681686
Name:WOODS, BRENDA L (DO)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:WOODS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3301 BERRYWOOD DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6517
Mailing Address - Country:US
Mailing Address - Phone:573-442-2442
Mailing Address - Fax:573-634-3146
Practice Address - Street 1:3301 BERRYWOOD DR
Practice Address - Street 2:SUITE #101
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6517
Practice Address - Country:US
Practice Address - Phone:573-442-2442
Practice Address - Fax:573-634-3146
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8F94208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE19645Medicare UPIN