Individual
TRACY R WOODWARD
Active
Individual
TRACY R WOODWARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01056773A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000280934
ANTHEM
IN
01
—
01056773A
LICENSE
IN
05
—
200404130A
—
IN
Enumeration date
08/23/2006
Last updated
07/08/2015
Update your record
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