Healthcare Provider Details

I. General information

NPI: 1053843995
Provider Name (Legal Business Name): ADDISON REED WOOD DO, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4812 S 109TH EAST AVE STE 300
TULSA OK
74146-5832
US

IV. Provider business mailing address

4802 S 109TH EAST AVE
TULSA OK
74146-5822
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-1400
  • Fax: 918-236-4587
Mailing address:
  • Phone: 918-392-1513
  • Fax: 918-392-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0071179
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: