Healthcare Provider Details

I. General information

NPI: 1194662445
Provider Name (Legal Business Name): MR. CONNOR AUGUSTUS WOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N JOHN R WOODEN DR
WEST LAFAYETTE IN
47907-2117
US

IV. Provider business mailing address

900 N JOHN R WOODEN DR
WEST LAFAYETTE IN
47907-2117
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-3245
  • Fax:
Mailing address:
  • Phone: 765-494-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: