Provider Demographics
NPI:1114924016
Name:WOOD, LARRY W (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:W
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1710 S 70TH ST
Mailing Address - Street 2:PO BOX 6068
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1676
Mailing Address - Country:US
Mailing Address - Phone:402-484-9000
Mailing Address - Fax:402-483-4223
Practice Address - Street 1:1710 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1676
Practice Address - Country:US
Practice Address - Phone:402-484-9000
Practice Address - Fax:402-483-4223
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE11443207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0800034OtherUNITED HEALTHCARE
NE1546OtherBLUE SHIELD
NE3473-02OtherHMO NEBRASKA
NE47062669803Medicaid
NE0800034OtherUNITED HEALTHCARE
NE3473-02OtherHMO NEBRASKA