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General NPI Number Information
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NPI Number | 1083983852
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Entity Type | Individual
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Provider Name | BRENT M. WOOD PAC
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Gender | Male
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 9400 N NAME UNO
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City | GILROY
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State | CA
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Zip | 95020-3528
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Country | US
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Telephone | 408-848-8672
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Fax | 408-848-4921
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Provider Business Mailing Address
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Address Line | 2100 POWELL ST SUITE 900
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City | EMERYVILLE
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State | CA
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Zip | 94608-1826
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Country | US
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Telephone | 510-350-2664
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Fax | 510-879-9130
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1320
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License Number State | NV
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