Provider Demographics
NPI:1306857149
Name:WOOD, PAUL DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:WOOD
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0728
Mailing Address - Country:US
Mailing Address - Phone:918-967-8814
Mailing Address - Fax:918-967-8894
Practice Address - Street 1:716 E MANITOBA AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3842
Practice Address - Country:US
Practice Address - Phone:509-925-3151
Practice Address - Fax:509-925-4382
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1476363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ60631Medicare UPIN