Provider Demographics
NPI:1952470965
Name:WOODS, JUSTIN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAMES
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 1:20652 N 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9309
Mailing Address - Country:US
Mailing Address - Phone:262-383-5517
Mailing Address - Fax:
Practice Address - Street 1:700 N ESTRELLA PKWY STE 120
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9271
Practice Address - Country:US
Practice Address - Phone:623-925-0636
Practice Address - Fax:623-925-0637
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62774207Q00000X
WI51230-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100003056Medicaid