Provider Demographics
NPI:1649670860
Name:MCGINNIS, WOODY
Entity type:Individual
Prefix:
First Name:WOODY
Middle Name:
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 CLOUDCREST DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9278
Mailing Address - Country:US
Mailing Address - Phone:541-326-8822
Mailing Address - Fax:
Practice Address - Street 1:11010 E PINAL VIS
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1520
Practice Address - Country:US
Practice Address - Phone:520-885-6821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10970208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice