Provider Demographics
NPI:1962515890
Name:WOODARD, MARY ANNA (MD)
Entity type:Individual
Prefix:
First Name:MARY ANNA
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S WHITE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2263
Mailing Address - Country:US
Mailing Address - Phone:319-385-6765
Mailing Address - Fax:319-385-6766
Practice Address - Street 1:407 S WHITE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2262
Practice Address - Country:US
Practice Address - Phone:319-385-6765
Practice Address - Fax:319-385-6766
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35834207VG0400X
TXG5465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14419Medicare PIN
IA20-1643245Medicare UPIN