Provider Demographics
NPI:1821299843
Name:WOOD, NATHANAEL (MD)
Entity Type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:11315 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3004
Practice Address - Country:US
Practice Address - Phone:253-859-8700
Practice Address - Fax:360-738-6377
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPENDING207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0222712OtherLIWA
WA0222714OtherLIWA
WA8119WOOtherBSWA
WA0222713OtherLIWA
WA1131WOOtherBSWA
WA8488124Medicaid
WA8119WOOtherBSWA
WA0222714OtherLIWA
WAG8867076Medicare PIN
WAP00411751Medicare PIN