Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G46774 | CA |
NPI | 1003834243 |
---|---|
Provider Name | David Lyman Wood |
First Address | Colton, CA 92324-7111 |
Second Address | Colton, CA 92324-7111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |