Healthcare Provider Details

I. General information

NPI: 1477996981
Provider Name (Legal Business Name): ANDREW MICHAEL WOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 S FEDERAL BLVD
DENVER CO
80219-4235
US

IV. Provider business mailing address

1339 S FEDERAL BLVD
DENVER CO
80219
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-0000
  • Fax:
Mailing address:
  • Phone: 303-602-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDR-0055633
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: