Provider Demographics
NPI:1023676897
Name:WOODYARD, DONALD RAY JR (NRP)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:WOODYARD
Suffix:JR
Gender:M
Credentials:NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6283 EBERSTARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5087
Mailing Address - Country:US
Mailing Address - Phone:614-230-5347
Mailing Address - Fax:
Practice Address - Street 1:6283 EBERSTARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5087
Practice Address - Country:US
Practice Address - Phone:614-230-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0081268207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services