Provider Demographics
NPI:1003865890
Name:WOOD, PETER BRIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRIAN
Last Name:WOOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6658 LONGFELLOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238
Mailing Address - Country:US
Mailing Address - Phone:972-980-7991
Mailing Address - Fax:
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:402 BARNETT TOWER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-824-7100
Practice Address - Fax:214-824-7128
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1568213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4776460001Medicare NSC
TX00555PMedicare PIN
TXU89899Medicare UPIN