1598714909 NPI number — MR. JEREMY JAKOB WOOD M.D.

Table of content: MR. JEREMY JAKOB WOOD M.D. (NPI 1598714909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598714909 NPI number — MR. JEREMY JAKOB WOOD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
JEREMY
Provider Middle Name:
JAKOB
Provider Name Prefix Text:
MR.
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:
1598714909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7777 HENNESSY BLVD
Provider Second Line Business Mailing Address:
SUITE 4000
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-766-7441
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 W PATRICK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21701-4858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-668-2020
Provider Business Practice Location Address Fax Number:
301-620-8729
Provider Enumeration Date:
05/10/2006

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: 207W00000X , with the licence number:  D0097046 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 0101240205 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 25642 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 33584 . This is a "CDS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 0101240205 . This is a "STATE LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1045926 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25642 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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