Provider Demographics
NPI:1487759403
Name:WOODARD, DAVID HERBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HERBERT
Last Name:WOODARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:HERBERT
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:8633 WOOD FLS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2534
Mailing Address - Country:US
Mailing Address - Phone:210-681-0686
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-699-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant