Healthcare Provider Details

I. General information

NPI: 1346335122
Provider Name (Legal Business Name): MARIE ELIZABETH WOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE ELIZABETH JONSEN M.D.

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number042-0009496
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberDR.0030632
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: