Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 5901001988 | MI |
NPI | 1619975869 |
---|---|
Provider Name | David S Wood |
First Address | Ironwood, MI 49938-9622 |
Second Address | Ironwood, MI 49938-9622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 05/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1032008 | PREFERREDONE (01) | |
132M8WO | BCBS (01) | MN |
43233300 | (05) | WI |
4431858 | (05) | MI |
48252750020 | BCBS (01) | MI |
U76031 | (02) |