Provider Demographics
NPI:1891781845
Name:WOOD, NATHAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:T
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 1:3702 BUFFALO TRL
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-3654
Mailing Address - Country:US
Mailing Address - Phone:254-773-6163
Mailing Address - Fax:
Practice Address - Street 1:6576 N 30TH ST W
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:OK
Practice Address - Zip Code:74454-3028
Practice Address - Country:US
Practice Address - Phone:254-624-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5186207Q00000X
OK20374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152425801Medicaid
H65891Medicare UPIN
TX152425801Medicaid