Healthcare Provider Details

I. General information

NPI: 1467608448
Provider Name (Legal Business Name): WOOD MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SE 8TH AVE
HILLSBORO OR
97123-4246
US

IV. Provider business mailing address

5319 SW WESTGATE DR 241
PORTLAND OR
97221-2411
US

V. Phone/Fax

Practice location:
  • Phone: 503-681-1111
  • Fax:
Mailing address:
  • Phone: 503-297-7223
  • Fax: 503-297-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD21064
License Number StateOR

VIII. Authorized Official

Name: DR. MATTHEW JOSEPH WOOD
Title or Position: OWNER
Credential: MD
Phone: 503-941-9663