Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 54865 | TN |
NPI | 1649561994 |
---|---|
Provider Name | Joshua Wood |
First Address | Memphis, TN 38105 |
Second Address | Memphis, TN 38105-4625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 14/06/2017 |