Provider Demographics
NPI:1457352452
Name:WOODS, WILLARD M JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLARD
Middle Name:M
Last Name:WOODS
Suffix:JR
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 1:1551 BRICE ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3505
Mailing Address - Country:US
Mailing Address - Phone:307-322-3861
Mailing Address - Fax:307-322-2018
Practice Address - Street 1:1551 BRICE ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3505
Practice Address - Country:US
Practice Address - Phone:307-322-3861
Practice Address - Fax:307-322-2018
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2725A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY301617OtherWY BC/BS
WY10223000Medicaid
WY10223000Medicaid
WY301617OtherWY BC/BS
WY10223000Medicaid