Provider Demographics
NPI:1912080979
Name:WOOD, RONALD ALLAN
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALLAN
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64802-0714
Mailing Address - Country:US
Mailing Address - Phone:417-529-5833
Mailing Address - Fax:417-206-4113
Practice Address - Street 1:1801 KATHERINE AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5888
Practice Address - Country:US
Practice Address - Phone:417-529-5833
Practice Address - Fax:417-206-4113
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO168076OtherBLUE CROSS BLUE SHIELD
MO4463870001Medicare ID - Type UnspecifiedMEDICARE