Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 39141 | NC |
NPI | 1902822976 |
---|---|
Provider Name | John Brian Thomas Wood |
First Address | Elizabeth City, NC 27909 |
Second Address | Elizabeth City, NC 27909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8988911 | (05) | NC |
F05628 | (02) |