Provider Demographics
NPI:1205091840
Name:KATHRYN J. WOOD, M.D., PA
Entity type:Organization
Organization Name:KATHRYN J. WOOD, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-769-9663
Mailing Address - Street 1:3550 PARKWOOD BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1903
Mailing Address - Country:US
Mailing Address - Phone:972-769-9663
Mailing Address - Fax:972-769-9664
Practice Address - Street 1:3550 PARKWOOD BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1903
Practice Address - Country:US
Practice Address - Phone:972-769-9663
Practice Address - Fax:972-769-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9363207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A62ROtherBC/BS
TX4046903OtherAETNA
TXC23745Medicare UPIN
TX4046903OtherAETNA