1013985142 NPI number — DR. JOHN E WOOD M.D.

Table of content: DR. JOHN E WOOD M.D. (NPI 1013985142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013985142 NPI number — DR. JOHN E WOOD M.D.

Organization/Personal Information

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

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:
1013985142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55805-1951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-723-1112
Provider Business Mailing Address Fax Number:
218-529-9120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 N 8TH AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55805-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-723-1112
Provider Business Practice Location Address Fax Number:
218-529-9120
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  32794 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 32794 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013985142 . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: P01132386 . This is a "RR MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013985142 . This is a "WEA TRUST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013985142 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013985142 . This is a "SECURITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1013985142 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013985142 . This is a "HUMANA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013985142 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013985142 . This is a "WEA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00010049222 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013985142 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013985142 . This is a "TRICARE/TRIWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1013985142 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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