Provider Demographics
NPI:1306891296
Name:WOODWARD, JEFFREY L (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:WOODWARD
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:PO BOX 9434
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-9434
Mailing Address - Country:US
Mailing Address - Phone:417-885-8888
Mailing Address - Fax:417-881-7638
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:WEST TOWER, SUITE 900
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-885-8888
Practice Address - Fax:417-881-7638
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7554208100000X
MO100758208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168118001Medicaid
MO4188130001OtherCIGNA MEDICARE
MO5421593001OtherCIGNA HEALTHCARE
MO203420716Medicaid
MO149639OtherBLUE CROSS/CHOICE
MOF10812OtherUSPS (W/C)
MO2086OtherCOX HEALTH PLANS UPI
MOF10812Medicare UPIN
MO203420716Medicaid
MO250013102Medicare PIN
MOMA3058011Medicare PIN
AR5H119Medicare PIN
MO5421593001OtherCIGNA HEALTHCARE
AR168118001Medicaid
MOMA3059011Medicare PIN