Provider Demographics
NPI:1750875969
Name:WOODWARD, NATHAN (DO)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 NE 82ND TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1313
Mailing Address - Country:US
Mailing Address - Phone:816-437-8161
Mailing Address - Fax:816-407-9603
Practice Address - Street 1:8880 NE 82ND TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1313
Practice Address - Country:US
Practice Address - Phone:816-437-8161
Practice Address - Fax:816-407-9603
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-11355207Q00000X
IADO-05506207Q00000X
MO2020022686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine