Provider Demographics
NPI:1063465524
Name:JOHN D. WOODY, MD, PA
Entity type:Organization
Organization Name:JOHN D. WOODY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-614-9863
Mailing Address - Street 1:PO BOX 863258
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3258
Mailing Address - Country:US
Mailing Address - Phone:855-496-3581
Mailing Address - Fax:844-876-0873
Practice Address - Street 1:3340 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1974
Practice Address - Country:US
Practice Address - Phone:317-614-9863
Practice Address - Fax:844-876-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273664100Medicaid
FL38562OtherBLUE CROSS BLUE SHIELD
FLDD6609OtherRAILROAD MEDICARE
FLDD6609OtherRAILROAD MEDICARE
FL38562OtherBLUE CROSS BLUE SHIELD