Healthcare Provider Details

I. General information

NPI: 1912957549
Provider Name (Legal Business Name): STEPHEN T WOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3264 N. NORTH HILLS BLVD FAYETTEVILLE SURGICAL ASSOCIATES PA
FAYETTEVILLE AR
72703-4005
US

IV. Provider business mailing address

3264 N. NORTH HILLS BLVD. FAYETTEVILLE SURGICAL ASSOCIATES PA
FAYETTEVILLE AR
72703-4005
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-3300
  • Fax: 479-521-4914
Mailing address:
  • Phone: 479-521-3300
  • Fax: 479-521-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC7347
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: