Provider Demographics
NPI:1477646875
Name:WOOD, CHAD N (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:N
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 1:699 S 45 E
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-5549
Mailing Address - Country:US
Mailing Address - Phone:801-602-7686
Mailing Address - Fax:
Practice Address - Street 1:1001 RIO VISTA DR
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-5463
Practice Address - Country:US
Practice Address - Phone:775-426-8276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8359118-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM63001276Medicaid
AZ134642Medicaid
CO54308216Medicaid
AZ134642Medicaid
NM63001276Medicaid
8HF540Medicare PIN
CO54308216Medicaid