MEDICARE: MR. DONALD WILLACE WOOD CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R0035409	OK

General Provider Information

NPI Number	:	1326040833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD WILLACE WOOD CRNA

Provider Business Mailing Address
First Line	:	3110 S VICTOR AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-2228
Country	:	US
Telephone Number	:	918-742-1884
Fax Number	:	918-742-6674

Provider Business Practice Location Address
First Line	:	3110 S VICTOR AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-2228
Country	:	US
Telephone Number	:	918-742-1884
Fax Number	:	918-742-6674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/12/2010

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