Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2004034269 | MO |
NPI | 1336209675 |
---|---|
Provider Name | Dr. Richard Hyrum Woodland |
First Address | Clinton, MO 64735-1192 |
Second Address | Clinton, MO 64735-1192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2006 |
Last Update Date | 16/11/2021 |