Provider Demographics
NPI:1184743163
Name:WOODARD, TRACI D (MD)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:D
Last Name:WOODARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 BLUEBONNET BLVD
Mailing Address - Street 2:APT. 12-5
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-7800
Mailing Address - Country:US
Mailing Address - Phone:225-247-9759
Mailing Address - Fax:
Practice Address - Street 1:3801 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3825
Practice Address - Country:US
Practice Address - Phone:225-655-6422
Practice Address - Fax:225-341-5903
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025775208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1044130Medicaid