Provider Demographics
NPI:1790792711
Name:WOOD, WILLIAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:E
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:213 E REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-2811
Mailing Address - Country:US
Mailing Address - Phone:918-774-1100
Mailing Address - Fax:918-774-1103
Practice Address - Street 1:213 E REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2811
Practice Address - Country:US
Practice Address - Phone:918-774-1100
Practice Address - Fax:918-774-1103
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20449208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK01-0763770OtherTAX ID
OK200004570AMedicaid
OK441186602003OtherOK BC/BS INDIVIDUAL
OK100091950AMedicaid
OK248311603OtherOK BC/BS GROUP NUMBER
OK441186602003OtherOK BC/BS INDIVIDUAL
OK800522243Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
OK248311603Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER