Provider Demographics
NPI:1942373980
Name:WOODARD, CHARLES BOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BOYD
Last Name:WOODARD
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:PO BOX 122539 DEPT 2539
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2539
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:2750 ASTER ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8824
Practice Address - Country:US
Practice Address - Phone:337-480-8900
Practice Address - Fax:337-480-8901
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012245207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1186236Medicaid
LAMD.012245OtherSTATE MEDICAL LICENSE
LAAW8105175OtherDEA
LA012245OtherMEDICAL LICENSE
LAAW8105175OtherDEA
LAB60547Medicare UPIN
LA8870OtherCDS