Basic Information
Provider Information
NPI: 1770873127
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOOD
FirstName: VALERIE
MiddleName: ANNE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 901 E 104TH ST
Address2: MAILSTOP 400N
City: KANSAS CITY
State: MO
PostalCode: 641314517
CountryCode: US
TelephoneNumber: 8165028752
FaxNumber: 8169329670
Practice Location
Address1: 4320 WORNALL RD
Address2: SUITE 512
City: KANSAS CITY
State: MO
PostalCode: 641115941
CountryCode: US
TelephoneNumber: 8169328663
FaxNumber: 8169325150
Other Information
ProviderEnumerationDate: 04/19/2011
LastUpdateDate: 06/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000X9999MOY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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