Provider Demographics
NPI:1285759274
Name:WOODS, JAMES HARLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HARLEY
Last Name:WOODS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 W NORTH AVENUE
Mailing Address - Street 2:#480
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2425
Mailing Address - Country:US
Mailing Address - Phone:414-778-6670
Mailing Address - Fax:414-778-6672
Practice Address - Street 1:10400 W NORTH AVENUE
Practice Address - Street 2:#480
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-2425
Practice Address - Country:US
Practice Address - Phone:414-778-6670
Practice Address - Fax:414-778-6672
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16936020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30149400Medicaid
WI020014186OtherRAILROAD MEDICARE
WI020014186OtherRAILROAD MEDICARE
WI201740Medicare ID - Type Unspecified