Healthcare Provider Details

I. General information

NPI: 1477558294
Provider Name (Legal Business Name): ROBERT ARMACOST WOOD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 W 151ST ST
OLATHE KS
66061-5350
US

IV. Provider business mailing address

5800 FOXRIDGE DR STE 240
MISSION KS
66202-2338
US

V. Phone/Fax

Practice location:
  • Phone: 913-791-4291
  • Fax: 913-791-4219
Mailing address:
  • Phone: 913-261-3153
  • Fax: 913-262-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number04-27412
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number114273
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: