Provider Demographics
NPI:1760652374
Name:WOOD, BRIAN S (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:WOOD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 HARDEN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3369
Mailing Address - Country:US
Mailing Address - Phone:919-788-8797
Mailing Address - Fax:919-788-8798
Practice Address - Street 1:3633 HARDEN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3369
Practice Address - Country:US
Practice Address - Phone:919-788-8797
Practice Address - Fax:919-788-8798
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-01292OtherLICENSE NUMBER
NC0010-01292OtherLICENSE NUMBER