Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 050071 | GA |
NPI | 1083615611 |
---|---|
Provider Name | Brennan P Wood |
First Address | Gainesville, GA 30501-7401 |
Second Address | Gainesville, GA 30501-7401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2005 |
Last Update Date | 20/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128458220A | (05) | GA |
I33556 | (02) | GA |