Provider Demographics
NPI:1720128564
Name:WOOD, THOMAS S (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:WOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15111 N HAYDEN RD
Mailing Address - Street 2:#160-352
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2581
Mailing Address - Country:US
Mailing Address - Phone:602-819-4898
Mailing Address - Fax:480-219-2803
Practice Address - Street 1:15111 N HAYDEN RD
Practice Address - Street 2:#160-352
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2581
Practice Address - Country:US
Practice Address - Phone:602-819-4898
Practice Address - Fax:480-219-2803
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391524636Medicare ID - Type Unspecified
AZZ144041Medicare PIN