Provider Demographics
NPI:1912973330
Name:WOODWARD, WILLIAM B JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
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:PO BOX 100517
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-0517
Mailing Address - Country:US
Mailing Address - Phone:817-731-7771
Mailing Address - Fax:817-731-7774
Practice Address - Street 1:501 S BURMA AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3426
Practice Address - Country:US
Practice Address - Phone:307-688-1244
Practice Address - Fax:307-688-1224
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5471A207ZP0101X, 207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY307127OtherBCBS
WY220032568OtherMEDICARE RR
WY122244900Medicaid
WY220032568OtherMEDICARE RR
WYW20679Medicare PIN