Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 27897 | OK |
NPI | 1003133026 |
---|---|
Provider Name | Misty Dawn Woodard |
First Address | Tulsa, OK 74136-3347 |
Second Address | Tulsa, OK 74132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2010 |
Last Update Date | 14/07/2015 |