Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | MD198914 | OR |
Y | 207T00000X | Neurosurgeon | MD198941 | OR |
NPI | 1063855641 |
---|---|
Provider Name | Dr. Jos'lyn Iman Woodard |
First Address | Portland, OR 97239-3098 |
Second Address | Portland, OR 97239-3098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2013 |
Last Update Date | 17/11/2020 |