Basic Information
| Provider Information | |||||||||
| NPI: | 1578590154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8401 DATAPOINT DR STE 600 | ||||||||
| Address2: | P. O. BOX 29407 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167700 | ||||||||
| FaxNumber: | 2106167709 | ||||||||
| Practice Location | |||||||||
| Address1: | 8401 DATAPOINT DR STE 600 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106167700 | ||||||||
| FaxNumber: | 2106167709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 04/07/2016 | ||||||||
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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 | 2085R0202X | K1324 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0700X | K1324 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085B0100X | K1324 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085D0003X | K1324 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | 2085U0001X | K1324 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085N0904X | K1324 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | K1324 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0204X | K1324 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2154809-03 | 05 | TX | MEDICAID | P00878879 | 01 | TX | RAILROAD MEDICARE | OTHER | K1324 | 01 | TX | TEXAS MEDICAL LICENSE | OTHER | 2154809-02 | 05 | TX | MEDICAID | P00878894 | 01 | TX | RAILROAD MEDICARE | OTHER | 2154809-01 | 05 | TX | MEDICAID |