Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 47252020 | WI |
NPI | 1003999483 |
---|---|
Provider Name | William Jonathan Wood |
First Address | Wauwatosa, WI 53226-1216 |
Second Address | Wauwatosa, WI 53226-1216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |