Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35.141407 | OH |
Y | 207X00000X | Orthopaedic Surgeon | 55080 | KY |
NPI | 1003260753 |
---|---|
Provider Name | Dorian Wood |
First Address | Edgewood, KY 41017-3405 |
Second Address | Crestview Hills, KY 41017-3418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 17/05/2021 |