Healthcare Provider Details

I. General information

NPI: 1598086373
Provider Name (Legal Business Name): TREY WOODS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N SANTIAM HWY
LEBANON OR
97355-4363
US

IV. Provider business mailing address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-3737
US

V. Phone/Fax

Practice location:
  • Phone: 541-258-2101
  • Fax:
Mailing address:
  • Phone: 541-768-5021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO161765
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number58.003141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: