Provider Demographics
NPI:1942342514
Name:WOODARD, ORLAND EUGENE (RRT)
Entity Type:Individual
Prefix:
First Name:ORLAND
Middle Name:EUGENE
Last Name:WOODARD
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-1507
Mailing Address - Country:US
Mailing Address - Phone:210-473-4729
Mailing Address - Fax:210-579-6582
Practice Address - Street 1:2002 S STEMMONS FWY
Practice Address - Street 2:STE 305
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-3632
Practice Address - Country:US
Practice Address - Phone:210-473-4729
Practice Address - Fax:210-579-6582
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58883227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTP015Medicare PIN