Basic Information
| Provider Information | |||||||||
| NPI: | 1679922264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODY | ||||||||
| FirstName: | MCKENZIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | VORHIES | ||||||||
| OtherFirstName: | MCKENZIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1202 MARTIN LUTHER KING JR. WAY | ||||||||
| Address2: | HILLTOP REGIONAL HEALTH CENTER | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534428718 | ||||||||
| FaxNumber: | 2534428790 | ||||||||
| Practice Location | |||||||||
| Address1: | 1202 MARTIN LUTHER KING JR. WAY | ||||||||
| Address2: | HILLTOP REGIONAL HEALTH CENTER | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534428718 | ||||||||
| FaxNumber: | 2534428790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2016 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OP60809385 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.