=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710098959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGORY D WOOD, MD OB/GYN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4505 E MCCAIN BLVD
-----------------------------------------------------
City | NORTH LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72117-2902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-955-9585
-----------------------------------------------------
Fax | 501-955-9394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4505 E MCCAIN BLVD
-----------------------------------------------------
City | NORTH LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72117-2902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-955-9585
-----------------------------------------------------
Fax | 501-955-9394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GREGORY DOUGLAS WOOD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 501-955-9585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | E2280
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------