=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487821344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY A WOOD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2008
-----------------------------------------------------
Last Update Date | 04/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W BROADWAY ST STE 320
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59802-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-329-5615
-----------------------------------------------------
Fax | 406-329-5606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 31001-4110
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91110-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-329-5615
-----------------------------------------------------
Fax | 406-329-5606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RA0001X
-----------------------------------------------------
Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
-----------------------------------------------------
License Number | MD60395018
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RA0001X
-----------------------------------------------------
Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
-----------------------------------------------------
License Number | MED-PHYS-LIC-141824
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD60395018
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD210689
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MED-PHYS-LIC-141824
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------