Individual
CLYDE W WOODYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2726 ELECTRIC RD, ROANOKE, VA 24018-3528
(540) 772-4448
(540) 772-0410
Mailing address
PO BOX 21435, ROANOKE, VA 24018-0551
(540) 772-4448
(540) 772-0410
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110840258
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006404995
—
VA
01
—
200026
LUNG
—
01
—
242488
ANTHEM
VA
01
—
541839718
C&O
—
01
—
54183971800
WV MEDICARE
WV
01
—
541839718042
BS MOUNTAIN STATE
VA
01
—
541839718043
BS MOUNTAIN STATE
WV
Enumeration date
06/16/2005
Last updated
01/26/2022
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