Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 58500 | MN |
N | 2081S0010X | Sports Medicine | 58500 | MN |
N | 213ES0000X | Sports Medicine | 58500 | MN |
Y | 2081S0010X | Sports Medicine | 69184 | WI |
Y | 213ES0000X | Sports Medicine | 69184 | WI |
NPI | 1033559877 |
---|---|
Provider Name | Dr. Ryan Woods |
First Address | Green Bay, WI 54303-2728 |
Second Address | Green Bay, WI 54311-8321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 24/10/2018 |