Basic Information
Provider Information
NPI: 1376960294
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOODRING
FirstName: SARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 94670
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731434670
CountryCode: US
TelephoneNumber: 4056823303
FaxNumber: 4053946793
Practice Location
Address1: 327 EASTBROOKE POINTE DR STE 200
Address2:  
City: MT WASHINGTON
State: KY
PostalCode: 400475561
CountryCode: US
TelephoneNumber: 5025385090
FaxNumber: 5025384089
Other Information
ProviderEnumerationDate: 03/28/2014
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X50517KYY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


Home