Provider Demographics
NPI:1528266392
Name:LAWRENCE LEONARD WOODS
Entity type:Organization
Organization Name:LAWRENCE LEONARD WOODS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-426-6070
Mailing Address - Street 1:107 SW 1ST ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-1201
Mailing Address - Country:US
Mailing Address - Phone:541-426-6070
Mailing Address - Fax:541-426-6079
Practice Address - Street 1:107 SW 1ST ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1201
Practice Address - Country:US
Practice Address - Phone:541-426-6070
Practice Address - Fax:541-426-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11341620292OtherINDIVIDUAL NPI #
OR109167Medicare ID - Type Unspecified
OR11341620292OtherINDIVIDUAL NPI #