Healthcare Provider Details

I. General information

NPI: 1295163624
Provider Name (Legal Business Name): WILLIAM WOOD MD SURGICAL ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 NE 102ND AVE
PORTLAND OR
97220-4169
US

IV. Provider business mailing address

PO BOX 27340
PHOENIX AZ
85061-7340
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-8490
  • Fax: 503-253-8497
Mailing address:
  • Phone: 602-943-9200
  • Fax: 602-216-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD15183
License Number StateOR

VIII. Authorized Official

Name: DR. WILLIAM JOSEPH WOOD JR.
Title or Position: PRESIDENT/PROVIDER
Credential: MD
Phone: 503-253-8490