Provider Demographics
NPI:1881690626
Name:WOOD, WILLIAM ROBERTS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERTS
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W.
Other - Middle Name:ROBERTS
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:SUITE 4140
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-4110
Mailing Address - Fax:937-208-6260
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:SUITE 4140
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-4110
Practice Address - Fax:937-208-6260
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-8813-W207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211930Medicaid
OH2211930Medicaid
OHH27569Medicare UPIN