Provider Demographics
NPI:1013538883
Name:WOOD, CORBIN CURTIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CORBIN
Middle Name:CURTIS
Last Name:WOOD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 S 1100 E STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1562
Mailing Address - Country:US
Mailing Address - Phone:801-355-6468
Mailing Address - Fax:801-355-3450
Practice Address - Street 1:24 S 1100 E STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1562
Practice Address - Country:US
Practice Address - Phone:801-355-6468
Practice Address - Fax:801-355-3450
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-02
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA0485363A00000X
UT12757354-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty