Provider Demographics
NPI:1093844086
Name:WOOD, THOMAS R (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:WOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 RANNOCH TRCE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8692
Mailing Address - Country:US
Mailing Address - Phone:479-431-7085
Mailing Address - Fax:
Practice Address - Street 1:7001 ROGERS AVE STE 502
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4041
Practice Address - Country:US
Practice Address - Phone:479-484-5901
Practice Address - Fax:479-484-0778
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19407207V00000X
ARE-5219207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology