MEDICARE: DR. BRENT S WOOD D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0000X	Sports Medicine Podiatrist	1890	TX
2	213ES0103X	Foot & Ankle Surgery Podiatrist	1890	TX
3	213EP1101X	Primary Podiatric Medicine Podiatrist	1890	TX

General Provider Information

NPI Number	:	1669606414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT S WOOD D.P.M.

Provider Business Mailing Address
First Line	:	1502 BLUE RIDGE DR STE 104
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-1002
Country	:	US
Telephone Number	:	512-719-4545
Fax Number	:	512-372-3396

Provider Business Practice Location Address
First Line	:	1502 BLUE RIDGE DR STE 104
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-1002
Country	:	US
Telephone Number	:	512-719-4545
Fax Number	:	512-372-3396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2009
Last Update Date	:	04/30/2025

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Directions to “ DR. BRENT S WOOD D.P.M.” Practice Location

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