Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G67525 | CA |
Y | 208600000X | Surgeon | G67525 | CA |
NPI | 1003994849 |
---|---|
Provider Name | John S. Wood |
First Address | Oakland, CA 94612-3429 |
Second Address | Vallejo, CA 94589-2441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G675250 | (05) | CA |
F12112 | (02) |