Provider Demographics
NPI:1902822323
Name:WOODIWISS, JAIMA PEYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIMA
Middle Name:PEYTON
Last Name:WOODIWISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAIMA
Other - Middle Name:PEYTON
Other - Last Name:HECOMOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13403 BOYETTE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-8742
Mailing Address - Country:US
Mailing Address - Phone:813-654-1775
Mailing Address - Fax:813-651-9082
Practice Address - Street 1:13403 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-8742
Practice Address - Country:US
Practice Address - Phone:813-654-1775
Practice Address - Fax:813-651-9082
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA818ZMedicare PIN