Individual
DR. STEPHAN KERMIT WOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2620 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4205
(308) 382-6856
(308) 381-1560
Mailing address
2808 OLD FAIR RD, GRAND ISLAND, NE 68803-5220
(308) 382-6856
(308) 381-1560
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0430987
KS
2085R0202X
Diagnostic Radiology Physician
Primary
12780
NE
2085R0202X
Diagnostic Radiology Physician
36619
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00422
BLUE CROSS BLUE SHIELD
NE
Enumeration date
06/30/2006
Last updated
03/07/2023
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