Healthcare Provider Details

I. General information

NPI: 1639191521
Provider Name (Legal Business Name): ANGELA M WOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SWAN HILL DR
BIGFORK MT
59911-6309
US

IV. Provider business mailing address

280 SWAN HILL DR
BIGFORK MT
59911-6309
US

V. Phone/Fax

Practice location:
  • Phone: 406-250-5625
  • Fax: 406-837-1401
Mailing address:
  • Phone: 406-250-5625
  • Fax: 406-837-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10112
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: