Provider Demographics
NPI:1922003102
Name:WOOD, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
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 1:2300 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4945
Mailing Address - Country:US
Mailing Address - Phone:501-548-6100
Mailing Address - Fax:501-548-6105
Practice Address - Street 1:2300 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4945
Practice Address - Country:US
Practice Address - Phone:501-548-6100
Practice Address - Fax:501-548-6105
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
ARC-7346207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122417001Medicaid
AR56444Medicare ID - Type Unspecified
AR122417001Medicaid