1225003114 NPI number — RICHARD E WOOD, M.D.

Table of content: (NPI 1225003114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225003114 NPI number — RICHARD E WOOD, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD E WOOD, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225003114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2575 COUNTY ROAD 220
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MIDDLEBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32068-6550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-213-1776
Provider Business Mailing Address Fax Number:
904-298-3698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2575 COUNTY ROAD 220
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MIDDLEBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32068-6550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-213-1776
Provider Business Practice Location Address Fax Number:
904-298-3698
Provider Enumeration Date:
02/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRIMARY DOCTOR
Authorized Official Telephone Number:
904-213-1776

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME36954 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7047637 . This is a "CLARENDON HEALTHY KIDS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 15575 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".