Provider Demographics
NPI:1972568525
Name:WOOD, ROBERT FRED (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRED
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2479 ASHTON RD
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354
Mailing Address - Country:US
Mailing Address - Phone:940-569-1864
Mailing Address - Fax:
Practice Address - Street 1:1105 BROOK
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301
Practice Address - Country:US
Practice Address - Phone:940-723-1441
Practice Address - Fax:940-766-3659
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2948207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C23726Medicare UPIN
TX80M472Medicare PIN