Healthcare Provider Details

I. General information

NPI: 1154548030
Provider Name (Legal Business Name): GLENN WOOD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 N MAYS ST STE 109
ROUND ROCK TX
78664-2166
US

IV. Provider business mailing address

2000 N MAYS ST STE 109
ROUND ROCK TX
78664-2166
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-9707
  • Fax: 512-374-9702
Mailing address:
  • Phone: 512-341-9707
  • Fax: 512-374-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENN G WOOD
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 512-341-9707