MEDICARE: SIARRA WOOD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA17646	TX

General Provider Information

NPI Number	:	1932830791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIARRA WOOD PA

Provider Business Mailing Address
First Line	:	PO BOX 35232
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-0630
Country	:	US
Telephone Number	:	817-375-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 W PARK DR STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-2034
Country	:	US
Telephone Number	:	817-375-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	03/02/2026

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Directions to “ SIARRA WOOD PA” Practice Location

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