Provider Demographics
NPI:1144264524
Name:WOOD, KAY L (MD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:L
Last Name:WOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 N HWY 89
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5993
Mailing Address - Country:US
Mailing Address - Phone:928-636-4355
Mailing Address - Fax:928-636-0754
Practice Address - Street 1:474 N HWY 89
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5993
Practice Address - Country:US
Practice Address - Phone:928-636-4355
Practice Address - Fax:928-636-0754
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70825174400000X
AZ44888207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA70825OtherSTATE
CA510421664OtherTAX ID
CABW6777859OtherDEA
CAW18346Medicare ID - Type Unspecified
CABW6777859OtherDEA