Provider Demographics
NPI:1386645919
Name:WOOD, DAVID DUANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DUANE
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5426
Mailing Address - Country:US
Mailing Address - Phone:559-732-0652
Mailing Address - Fax:559-625-1677
Practice Address - Street 1:1914 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5426
Practice Address - Country:US
Practice Address - Phone:559-732-0652
Practice Address - Fax:559-625-1677
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10423103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY10423Medicare UPIN