Healthcare Provider Details

I. General information

NPI: 1720089030
Provider Name (Legal Business Name): LARRY K WOOD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 MEMORIAL DR SUITE 300
DENISON TX
75020-2079
US

IV. Provider business mailing address

1014 MEMORIAL DR SUITE 300
DENISON TX
75020-2079
US

V. Phone/Fax

Practice location:
  • Phone: 903-465-2020
  • Fax: 903-465-1606
Mailing address:
  • Phone: 903-465-2020
  • Fax: 903-465-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberH8526
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberH8526
License Number StateTX

VIII. Authorized Official

Name: DR. LARRY KEITH WOOD
Title or Position: PRESIDENT
Credential: MD
Phone: 903-465-2020