MEDICARE: SAMANTHA RAY WOOD PA-C

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	363AM0700X	Medical Physician Assistant	PA0009842	CO

General Provider Information

NPI Number	:	1689492696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA RAY WOOD PA-C

Provider Business Mailing Address
First Line	:	5445 DTC PKWY STE 1050
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-3079
Country	:	US
Telephone Number	:	720-263-6290
Fax Number	:

Provider Business Practice Location Address
First Line	:	5445 DTC PKWY STE 1050
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-3079
Country	:	US
Telephone Number	:	720-263-6290
Fax Number	:

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

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	06/04/2026

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