Healthcare Provider Details

I. General information

NPI: 1114924016
Provider Name (Legal Business Name): LARRY W WOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 S 70TH ST
LINCOLN NE
68506-1676
US

IV. Provider business mailing address

1710 S 70TH ST PO BOX 6068
LINCOLN NE
68506-1676
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-9000
  • Fax: 402-483-4223
Mailing address:
  • Phone: 402-484-9000
  • Fax: 402-483-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11443
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: