Provider Demographics
NPI:1932235785
Name:WOODARD, ERIC ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ANTHONY
Last Name:WOODARD
Suffix:
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 607
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0607
Mailing Address - Country:US
Mailing Address - Phone:501-450-6400
Mailing Address - Fax:501-450-6440
Practice Address - Street 1:525 HENDRIX CV
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7742
Practice Address - Country:US
Practice Address - Phone:501-450-6400
Practice Address - Fax:501-450-6440
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110172873OtherMEDICARE ID
110172873OtherMEDICARE ID
ARG68541Medicare UPIN