Provider Demographics
NPI:1831400506
Name:WOODALL, MONICA MAE (DO)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:MAE
Last Name:WOODALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:MAE
Other - Last Name:MCLAREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5012 S US HWY 75, SUITE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:580-920-1922
Mailing Address - Fax:
Practice Address - Street 1:698 WESTSIDE DR STE 110
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3085
Practice Address - Country:US
Practice Address - Phone:580-920-1922
Practice Address - Fax:580-920-1923
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200292410AMedicaid
OK200292410AMedicaid