Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1568 | TX |
Y | 222Z00000X | Podiatrist | 1568 | TX |
NPI | 1003865890 |
---|---|
Provider Name | Dr. Peter Brian Wood |
First Address | Dallas, TX 75238 |
Second Address | Dallas, TX 75246-1800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 08/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U89899 | (02) | TX |