MEDICARE: DOUGLAS MICHAEL 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	207Q00000X	Family Medicine Physician	H7258	TX
2	208D00000X	General Practice Physician	H7258	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H7258	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1962828731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS MICHAEL WOOD D.O.

Provider Business Mailing Address
First Line	:	301 W AVENUE D
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-7117
Country	:	US
Telephone Number	:	214-557-7814
Fax Number	:	972-947-3057

Provider Business Practice Location Address
First Line	:	301 W AVENUE D
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-7117
Country	:	US
Telephone Number	:	214-557-7814
Fax Number	:	972-947-3057

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

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	03/17/2014

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