Basic Information
| Provider Information | |||||||||
| NPI: | 1689731655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 565 | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835220565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089623267 | ||||||||
| FaxNumber: | 2089622313 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 LEWISTON STREET | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835220565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089623267 | ||||||||
| FaxNumber: | 2089622313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207L00000X | M7876 | ID | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.