Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 161740-1205 | UT |
NPI | 1144212580 |
---|---|
Provider Name | James S Wood |
First Address | Murray, UT 84107-4814 |
Second Address | Murray, UT 84107-4814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 22/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D20173 | (02) | UT |