Healthcare Provider Details

I. General information

NPI: 1922057124
Provider Name (Legal Business Name): WILLIAM A WOOD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

PO BOX 12469
WESTMINSTER CA
92685-2469
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4444
  • Fax:
Mailing address:
  • Phone: 866-325-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA17186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: