Provider Demographics
NPI:1306950795
Name:WOOD, DANIEL (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 FALLOW RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1806
Mailing Address - Country:US
Mailing Address - Phone:210-386-7882
Mailing Address - Fax:210-923-4131
Practice Address - Street 1:7355 BARLITE BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1342
Practice Address - Country:US
Practice Address - Phone:210-928-7538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85N928Medicare ID - Type Unspecified
TXP30054Medicare UPIN