Provider Demographics
NPI:1982473328
Name:WOODARD, CLAYTON MINOR
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:MINOR
Last Name:WOODARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 E 146TH PL S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-8045
Mailing Address - Country:US
Mailing Address - Phone:405-371-5204
Mailing Address - Fax:
Practice Address - Street 1:3201 E 146TH PL S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-8045
Practice Address - Country:US
Practice Address - Phone:405-371-5204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist