Gerald R Woodard DO PA

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

OS4717 Issued in FL

Legal business name

GERALD R WOODARD DO PA

Doing business as

Shores Medical Center Daytona

Practice address

3512 S Atlantic Ave
Daytona Beach Shores, FL 32118-7639

Phone

(386) 767-9544

NPI assigned

May 13, 2014

Last updated

May 13, 2014By the provider in NPPES

Organization subpart

Yes

Parent organization

MEDVANTX, INC,As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• Shores Medical Center Daytona Doing business as

Part of

Medvantx Inc

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gerald R Woodard, D.O.

  • Family Medicine Physician
  • Daytona Beach Shores, FL
  • NPI 1700877388
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1497166417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3512 S ATLANTIC AVE",
            "city": "DAYTONA BEACH SHORES",
            "state": "FL",
            "postal_code": "321187639",
            "telephone_number": "386-767-9544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERALD R WOODARD DO PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC,",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "OS4717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shores Medical Center Daytona",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James Evensen, MA BCBA
• Zalika A Freeman
• Bettina Fulford, ARNP
• David Gaughan, M,D.
• Gerald R Woodard DO PA (Shores Medical Center)
• Lauren A Girard, DO
• Jamera F Givens
• Hassan Alkhatib MD PA
• Heritage Waterside
• Alesen Hernandez

• Non-Pharmacy Dispensing Site in Daytona Beach Shores, FL
• Providers in Daytona Beach Shores, FL by specialty
• Non-Pharmacy Dispensing Site in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.