Provider Demographics
NPI:1861509333
Name:WOOD, LAWRENCE P (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:P
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140349
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0349
Mailing Address - Country:US
Mailing Address - Phone:907-274-7977
Mailing Address - Fax:
Practice Address - Street 1:2751 DEBARR RD
Practice Address - Street 2:SUITE 390
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-274-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK35882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300130885OtherRAILROAD MEDICARE
AKMD3588Medicaid
151929Medicare ID - Type Unspecified
AKMD3588Medicaid