Provider Demographics
NPI:1720859176
Name:WOODARD, JACOB HERBERT
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:HERBERT
Last Name:WOODARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 APOLLO WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1944
Mailing Address - Country:US
Mailing Address - Phone:217-622-7998
Mailing Address - Fax:
Practice Address - Street 1:2087 ACORN BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-7306
Practice Address - Country:US
Practice Address - Phone:317-738-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant