Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 30317 | MN |
NPI | 1952481657 |
---|---|
Provider Name | Robert J Wood |
First Address | Mesa, AZ 85202-4773 |
Second Address | Mesa, AZ 85202-4773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 07/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
536715800 | (05) | MN |
E85909 | (02) |