Individual
DR. KYLE C WOODERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
601 E 13TH ST, STE H, GROVE, OK 74344-2989
(918) 786-7300
(918) 786-7303
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(918) 786-7300
(918) 786-7303
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4824
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200254780A
—
OK
05
—
200505990O
—
OK
Enumeration date
07/07/2009
Last updated
04/05/2017
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