Provider Demographics
NPI:1992716088
Name:WOODWARD, GARY J (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:815 COURT ST
Practice Address - Street 2:STE 7
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2154
Practice Address - Country:US
Practice Address - Phone:209-257-5900
Practice Address - Fax:209-257-5901
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG30825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G308250Medicaid
CA00G308250Medicare PIN
CA00G308250Medicaid