Individual
MS. THERESA LYNETTE WOODARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
539 BERTRAND DR, LAFAYETTE, LA 70506-5556
(337) 294-1230
(833) 749-0347
Mailing address
539 BERTRAND DR, LAFAYETTE, LA 70506-5556
(337) 294-1230
(833) 749-0347
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
48083
TN
207R00000X
Internal Medicine Physician
Primary
199982
LA
207R00000X
Internal Medicine Physician
48083
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103I113900
MEDICARE
TN
05
—
1050636
—
LA
05
—
1527156
—
TN
01
—
199982
STATE MEDICAL LICENSE
LA
01
—
48083
STATE MEDICAL LICENSE
TN
Enumeration date
07/17/2006
Last updated
03/07/2023
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