Provider Demographics
NPI:1720089030
Name:LARRY K WOOD MD PA
Entity type:Organization
Organization Name:LARRY K WOOD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-465-2020
Mailing Address - Street 1:1014 MEMORIAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2079
Mailing Address - Country:US
Mailing Address - Phone:903-465-2020
Mailing Address - Fax:903-465-1606
Practice Address - Street 1:1014 MEMORIAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2079
Practice Address - Country:US
Practice Address - Phone:903-465-2020
Practice Address - Fax:903-465-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8526207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100755440AOtherMEDICAID
TX0032HDOtherBLUE CROSS
TX148685401Medicaid
TX0032HDOtherBLUE CROSS
F53418Medicare UPIN
TX00042TMedicare ID - Type Unspecified
TX148685401Medicaid