Provider Demographics
NPI:1578551370
Name:WOOD, WILLIAM WYATT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WYATT
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1495 NORTHROCK CT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1233
Mailing Address - Country:US
Mailing Address - Phone:815-965-1817
Mailing Address - Fax:815-965-9574
Practice Address - Street 1:1495 NORTHROCK CT
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-1233
Practice Address - Country:US
Practice Address - Phone:815-885-1462
Practice Address - Fax:815-885-2895
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0762772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE85628Medicare UPIN