Provider Demographics
NPI:1821044066
Name:WOODS, GREGORY N (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:N
Last Name:WOODS
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 1:2114 N LINCOLN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1028
Mailing Address - Country:US
Mailing Address - Phone:402-362-5555
Mailing Address - Fax:402-362-7137
Practice Address - Street 1:2114 N LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1028
Practice Address - Country:US
Practice Address - Phone:402-362-5555
Practice Address - Fax:402-362-7137
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE264560OtherPTAN
NE47077294513Medicaid
NE19500OtherNE STATE LICENSE NUMBER
CO31701OtherSTATE LICENSE NUMBER
NE264560OtherPTAN
NE19500OtherNE STATE LICENSE NUMBER