Provider Demographics
NPI:1013991918
Name:PATRA, WOODY (MD)
Entity Type:Individual
Prefix:MR
First Name:WOODY
Middle Name:
Last Name:PATRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:WERAWOOT
Other - Middle Name:
Other - Last Name:PATRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3335 PLACER ST
Mailing Address - Street 2:#112
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2364
Mailing Address - Country:US
Mailing Address - Phone:530-246-3857
Mailing Address - Fax:
Practice Address - Street 1:3335 PLACER ST
Practice Address - Street 2:#112
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2364
Practice Address - Country:US
Practice Address - Phone:530-246-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33431174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A334310Medicaid
CA00A334310Medicaid