Provider Demographics
NPI:1912715020
Name:WOODARD, HUNTUR B (PAC)
Entity type:Individual
Prefix:
First Name:HUNTUR
Middle Name:B
Last Name:WOODARD
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-5054
Mailing Address - Country:US
Mailing Address - Phone:484-503-8281
Mailing Address - Fax:
Practice Address - Street 1:1648 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-5054
Practice Address - Country:US
Practice Address - Phone:484-503-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA066288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant