Provider Demographics
NPI:1548243645
Name:WOODWARD, KELLY H I (DO, MPH)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:H
Last Name:WOODWARD
Suffix:I
Gender:M
Credentials:DO, MPH
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Mailing Address - Street 1:7165 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5382
Mailing Address - Country:US
Mailing Address - Phone:703-907-9716
Mailing Address - Fax:
Practice Address - Street 1:5532 LILLEHAMMER LN STE 102
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6078
Practice Address - Country:US
Practice Address - Phone:435-659-7633
Practice Address - Fax:971-397-0394
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2025-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT9693614-1204207Q00000X, 2083P0901X, 2083P0901X
VA01022019962083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine