Provider Demographics
NPI:1578506770
Name:WOOD, JULIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
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 1:6675 HOLMES RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1150
Mailing Address - Country:US
Mailing Address - Phone:816-276-7600
Mailing Address - Fax:816-276-7090
Practice Address - Street 1:6675 HOLMES RD
Practice Address - Street 2:SUITE 360
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1150
Practice Address - Country:US
Practice Address - Phone:816-276-7600
Practice Address - Fax:816-276-7992
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208288944Medicaid
KS100308030 CMedicaid
KS100308030BMedicaid
MO208288936Medicaid
KS20-860920-02Medicaid
MO208288944Medicaid
MOP538187Medicare ID - Type UnspecifiedMEDICARE B - GOPPERT
MOP00118242Medicare ID - Type UnspecifiedRAILROAD MEDICARE -GOPPER