Healthcare Provider Details

I. General information

NPI: 1710098959
Provider Name (Legal Business Name): GREGORY D WOOD, MD OB/GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 E MCCAIN BLVD
NORTH LITTLE ROCK AR
72117-2902
US

IV. Provider business mailing address

4505 E MCCAIN BLVD
NORTH LITTLE ROCK AR
72117-2902
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-9585
  • Fax: 501-955-9394
Mailing address:
  • Phone: 501-955-9585
  • Fax: 501-955-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE2280
License Number StateAR

VIII. Authorized Official

Name: DR. GREGORY DOUGLAS WOOD
Title or Position: OWNER
Credential: MD
Phone: 501-955-9585