Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 44888 | AZ |
NPI | 1144264524 |
---|---|
Provider Name | Dr. Kay L Wood |
First Address | Chino Valley, AZ 86323-5993 |
Second Address | Chino Valley, AZ 86323-5993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 22/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
510421664 | TAX ID (01) | CA |
A70825 | STATE (01) | CA |
BW6777859 | DEA (01) | CA |
H80435 | (02) | CA |