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General NPI Number Information
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NPI Number | 1346247749
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Entity Type | Individual
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Provider Name | GLENN GORDON WOOD M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 7112 ED BLUESTEIN BLVD STE 100
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City | AUSTIN
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State | TX
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Zip | 78723-2900
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Country | US
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Telephone | 512-744-6000
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Fax | 512-583-5462
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Provider Business Mailing Address
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Address Line | 9411 N LAMAR BLVD STE 120
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City | AUSTIN
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State | TX
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Zip | 78753-4179
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Country | US
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Telephone | 512-583-9679
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Fax | 512-233-0985
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | F4706
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License Number State | TX
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