MEDICARE: GLENN WOOD MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1043581275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENN WOOD MD PA

Provider Business Mailing Address
First Line	:	2621 RIDGEPOINT DR
Second Line	:	STE 130
City	:	AUSTIN
State	:	TX
Zip	:	78754-5232
Country	:	US
Telephone Number	:	512-583-9679
Fax Number	:	512-334-2321

Provider Business Practice Location Address
First Line	:	109 S TEXAS AVE
Second Line	:	STE E
City	:	MERCEDES
State	:	TX
Zip	:	78570-2725
Country	:	US
Telephone Number	:	512-744-6000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	TRACI DIXSON
Credential	:
Telephone Number	:	512-583-9680

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	01/19/2012

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Directions to “GLENN WOOD MD PA ” Practice Location

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