MEDICARE: DR. GARY LEE WOOD MD

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	2085R0202X	Diagnostic Radiology Physician	MD60403656	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992709604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY LEE WOOD MD

Provider Business Mailing Address
First Line	:	19020 33RD AVE W STE 210
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-4748
Country	:	US
Telephone Number	:	425-563-1500
Fax Number	:	425-563-1374

Provider Business Practice Location Address
First Line	:	3900 CAPITAL MALL DR SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8654
Country	:	US
Telephone Number	:	360-754-5858
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	11/08/2018

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