Provider Demographics
NPI:1720247604
Name:WOODWARD, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 TURTLE COVE BLVD
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5384
Mailing Address - Country:US
Mailing Address - Phone:469-769-1101
Mailing Address - Fax:469-769-1102
Practice Address - Street 1:500 TURTLE COVE BLVD
Practice Address - Street 2:SUITE 110A
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5384
Practice Address - Country:US
Practice Address - Phone:469-769-1101
Practice Address - Fax:469-769-1102
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG85182084P0800X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23761Medicare UPIN