MEDICARE: RYAN T WOOD D.O.

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	208M00000X	Hospitalist Physician	4263	AZ
2	207R00000X	Internal Medicine Physician	4263	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558358994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN T WOOD D.O.

Provider Business Mailing Address
First Line	:	3655 W ANTHEM WAY
Second Line	:	SUITE A109 PMB 313
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0430
Country	:	US
Telephone Number	:	623-505-9880
Fax Number	:	623-505-9880

Provider Business Practice Location Address
First Line	:	3655 W ANTHEM WAY
Second Line	:	SUITE 109 PMB 313
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0430
Country	:	US
Telephone Number	:	623-505-9880
Fax Number	:	623-505-9880

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	12/08/2022

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Directions to “ RYAN T WOOD D.O.” Practice Location

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