Healthcare Provider Details

I. General information

NPI: 1003865890
Provider Name (Legal Business Name): PETER BRIAN WOOD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 GASTON AVE 402 BARNETT TOWER
DALLAS TX
75246-1800
US

IV. Provider business mailing address

6658 LONGFELLOW DRIVE
DALLAS TX
75238
US

V. Phone/Fax

Practice location:
  • Phone: 214-824-7100
  • Fax: 214-824-7128
Mailing address:
  • Phone: 972-980-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1568
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: