Provider Demographics
NPI:1871586685
Name:WOOD, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6529 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1139
Mailing Address - Country:US
Mailing Address - Phone:602-769-3915
Mailing Address - Fax:
Practice Address - Street 1:8111 E THOMAS RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5876
Practice Address - Country:US
Practice Address - Phone:480-907-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012823702085R0202X
AZ354492085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ214287OtherMEDICARE PTAN
AZ113834Medicaid
VT138582OtherANTHEM
TN4085050OtherBCBS
TNR06903OtherJOHN DEERE
VA010094631Medicaid
P00131105OtherPGBA (RR MEDICARE)
TN3893294Medicaid
AZZ148084OtherPTAN