Provider Demographics
NPI:1720082266
Name:WOODSON, ALEXA G (MD)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:G
Last Name:WOODSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:GARNER
Other - Last Name:BRAITHWAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-917-3518
Mailing Address - Fax:405-951-4361
Practice Address - Street 1:3500 NW 56TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4529
Practice Address - Country:US
Practice Address - Phone:405-917-3518
Practice Address - Fax:405-951-4361
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK245519606OtherMEDICARE NUMBER