Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | A141789 | CA |
N | 208000000X | Pediatrician | A141789 | CA |
NPI | 1184041360 |
---|---|
Provider Name | Jeremy Woods |
First Address | Madera, CA 93636-8761 |
Second Address | Madera, CA 93636-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 10/06/2020 |