Provider Demographics
NPI:1366615189
Name:WOOD, WILLIAM ANTHONY
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANTHONY
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 1:2008 NEW YORK AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1700
Mailing Address - Country:US
Mailing Address - Phone:512-293-5565
Mailing Address - Fax:
Practice Address - Street 1:1400 S CONGRESS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2435
Practice Address - Country:US
Practice Address - Phone:512-293-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY LICENSE171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist