Active NPI
Stephen Gordon Woodyard, D.M.D.,M.S.
- Periodontics
- Portland, OR
National Provider Identifier
1013106681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- D4180
- Practice address
- 1585 SW Marlow Ave
Portland, OR 97225-5176 - Phone
- (503) 297-1444
- NPI assigned
- Oct 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | D4180 | OR | Primary |
Addresses
Primary practice location
1585 SW Marlow Ave
Portland, OR 97225-5176
Mailing address
1585 SW Marlow Ave
Portland, OR 97225-5176
Phone (503) 297-1444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D4180 | OR | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192752000000",
"number": "1013106681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1585 SW MARLOW AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255176",
"telephone_number": "503-297-1444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1585 SW MARLOW AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255176",
"telephone_number": "503-297-1444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODYARD",
"first_name": "STEPHEN",
"middle_name": "GORDON",
"credential": "D.M.D.,M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-19",
"last_updated": "2007-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "OR",
"license": "D4180",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.