Provider Demographics
NPI:1851491575
Name:WOOD, DEAN R (PA)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:R
Last Name:WOOD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:D128 WEST FEE HALL
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1315
Mailing Address - Country:US
Mailing Address - Phone:517-355-3503
Mailing Address - Fax:517-432-1167
Practice Address - Street 1:OLIN HEALTH CENTER
Practice Address - Street 2:EAST CIRCLE DRIVE
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824
Practice Address - Country:US
Practice Address - Phone:517-355-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant