Healthcare Provider Details

I. General information

NPI: 1073664256
Provider Name (Legal Business Name): LESLIE ANN WOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGERS BROOKE DRIVE SAN ANTONIO MILITARY MEDICAL CENTER
FORT SAM HOUSTON TX
78234-9416
US

IV. Provider business mailing address

311 OGDEN LN
SAN ANTONIO TX
78209-5138
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-9844
  • Fax:
Mailing address:
  • Phone: 907-738-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4170
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberBP10045125
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: