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General NPI Number Information
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NPI Number | 1649561994
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Entity Type | Individual
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Provider Name | JOSHUA WOOD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 06/14/2017
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Provider Practice Location Address
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Address Line | 51 N DUNLAP ST STE G10
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City | MEMPHIS
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State | TN
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Zip | 38105-4625
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Country | US
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Telephone | 901-287-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 850 POPLAR AVE. BUILDING 2
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City | MEMPHIS
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State | TN
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Zip | 38105
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Country | US
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Telephone | 901-287-5565
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 54865
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License Number State | TN
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