Healthcare Provider Details

I. General information

NPI: 1649686254
Provider Name (Legal Business Name): DANIEL WOOD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

PO BOX 1303
FRISCO CO
80443-1303
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 970-668-3633
  • Fax: 970-668-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0003954
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: