Provider Demographics
NPI:1407812712
Name:WOOD, BEVERLY GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:GAIL
Last Name:WOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5934
Mailing Address - Country:US
Mailing Address - Phone:817-684-5200
Mailing Address - Fax:817-684-5205
Practice Address - Street 1:1615 HOSPITAL PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5934
Practice Address - Country:US
Practice Address - Phone:817-684-5200
Practice Address - Fax:817-684-5205
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R35LMedicare ID - Type Unspecified
TXF69508Medicare UPIN