Provider Demographics
NPI:1912141557
Name:WOODS, BOBBY L (IDMT)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:L
Last Name:WOODS
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:MR
Other - First Name:BOB
Other - Middle Name:L
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDMT
Mailing Address - Street 1:310 WORCHESTER AVE BLDG 45
Mailing Address - Street 2:JPAC MEDICAL SECTION
Mailing Address - City:HICKAM AFB
Mailing Address - State:HI
Mailing Address - Zip Code:96853-5530
Mailing Address - Country:US
Mailing Address - Phone:808-474-4957
Mailing Address - Fax:808-474-4880
Practice Address - Street 1:310 WORCHESTER AVE BLDG 45
Practice Address - Street 2:JPAC MEDICAL SECTION
Practice Address - City:HICKAM AFB
Practice Address - State:HI
Practice Address - Zip Code:96853-5530
Practice Address - Country:US
Practice Address - Phone:808-474-4957
Practice Address - Fax:808-474-4880
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians