Provider Demographics
NPI:1013241470
Name:WOODSON, ELENA BETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:BETH
Last Name:WOODSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELENA
Other - Middle Name:BETH
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9900 BROADWAY EXT STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6323
Mailing Address - Country:US
Mailing Address - Phone:405-608-8333
Mailing Address - Fax:405-608-8818
Practice Address - Street 1:9900 BROADWAY EXT STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6323
Practice Address - Country:US
Practice Address - Phone:405-608-8833
Practice Address - Fax:405-608-8818
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31155207YP0228X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology