Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2021010145 | MO |
Y | 207VX0201X | Gynecologic Oncologist | 2021010145 | MO |
NPI | 1285160457 |
---|---|
Provider Name | Tyler Jeffrey Woodard |
First Address | Saint Louis, MO 63112-2143 |
Second Address | Saint Louis, MO 63110-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2017 |
Last Update Date | 01/11/2021 |