Provider Demographics
NPI:1821023409
Name:WOODARD, LUCILLE R (MD)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:R
Last Name:WOODARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUCILLE
Other - Middle Name:R
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7100 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2714
Mailing Address - Country:US
Mailing Address - Phone:402-506-9000
Mailing Address - Fax:402-506-9093
Practice Address - Street 1:7100 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2714
Practice Address - Country:US
Practice Address - Phone:402-506-9000
Practice Address - Fax:402-506-9093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5304207Q00000X
NE23834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10028650200Medicaid