Basic Information
| Provider Information | |||||||||
| NPI: | 1457329542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73720 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997073720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099909640 | ||||||||
| FaxNumber: | 9074593500 | ||||||||
| Practice Location | |||||||||
| Address1: | 1919 LATHROP ST | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997015937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074593500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 12/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10003794 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 139988 | AK | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | 139988 | AK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 000010017647 | 01 | ID | REGENCE BLUE SHIELD OF ID | OTHER | 970019578 | 01 | WA | RR MEDICARE | OTHER | 8929877 | 01 | WA | CRIME VICTIMS | OTHER | WO4266 | 01 | WA | ASURIS NW HEALTH | OTHER | 379109600 | 01 | WA | OWCP | OTHER | 003783300 | 05 | ID | MEDICAID | 149074 | 01 | WA | DEPT OF LABOR & INDUSTRI | OTHER | 15388 | 01 | WA | GROUP HEALTH NW | OTHER | 8387359 | 05 | WA | MEDICAID | KQ506 | 01 | ID | BLUE CROSS OF IDAHO | OTHER |