Provider Demographics
NPI:1225040645
Name:WOOD, GREGORY DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DOUGLAS
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 1:9 RIVER RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-1523
Mailing Address - Country:US
Mailing Address - Phone:501-955-9585
Mailing Address - Fax:501-955-9394
Practice Address - Street 1:4505 E MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2902
Practice Address - Country:US
Practice Address - Phone:501-955-9585
Practice Address - Fax:501-955-9394
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2280207V00000X
PAMD480173207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139013001Medicaid
AR5L366Medicare ID - Type Unspecified
AR139013001Medicaid