Healthcare Provider Details

I. General information

NPI: 1750332276
Provider Name (Legal Business Name): WALTER S WOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N 22ND ST
BLAIR NE
68008-1128
US

IV. Provider business mailing address

9824 PIERCE ST
OMAHA NE
68124-1150
US

V. Phone/Fax

Practice location:
  • Phone: 402-426-2182
  • Fax: 402-426-1190
Mailing address:
  • Phone: 402-553-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21916
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34081
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: