Provider Demographics
NPI:1780796656
Name:WOODWARD, HALBERT OWEN JR (MD)
Entity type:Individual
Prefix:
First Name:HALBERT
Middle Name:OWEN
Last Name:WOODWARD
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 1:2500 CROCKETT DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5900
Mailing Address - Country:US
Mailing Address - Phone:325-643-5456
Mailing Address - Fax:325-643-9590
Practice Address - Street 1:2500 CROCKETT DRIVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5900
Practice Address - Country:US
Practice Address - Phone:325-643-5456
Practice Address - Fax:325-643-9590
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1189208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0084GSOtherBCBS GROUP
118823OtherSUPERIOR
8B8061OtherBCBS DR
2323763OtherBLUE LINK
44163OtherAMERIGROUP
44163OtherAMERIGROUP
8B8061OtherBCBS DR