Provider Demographics
NPI:1790788347
Name:WOODARD, JOSEPH PAUL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PAUL
Last Name:WOODARD
Suffix:JR
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 1:2533 VISTA WOOD CIR APT 14
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5703
Mailing Address - Country:US
Mailing Address - Phone:650-867-1985
Mailing Address - Fax:
Practice Address - Street 1:1 AMGEN CENTER DR
Practice Address - Street 2:MS: 38-3-A
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-1730
Practice Address - Country:US
Practice Address - Phone:805-447-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC533342080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104670481Medicaid
AR137421001Medicaid
MS00120746Medicaid
IN200236490AMedicaid
TN3897777Medicaid
MT0149539Medicaid
MO205030604Medicaid
KS200377110AMedicaid
OH2122670Medicaid
AZ564949Medicaid
NC7612969Medicaid
IA0529081Medicaid
OK100034940AMedicaid
ME422400000Medicaid
KY64712540Medicaid
NE100249681-00Medicaid
LA1429813Medicaid
AL009913970Medicaid
AL009913970Medicaid