Healthcare Provider Details

I. General information

NPI: 1225003114
Provider Name (Legal Business Name): RICHARD E WOOD, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 COUNTY ROAD 220 SUITE 103
MIDDLEBURG FL
32068-6550
US

IV. Provider business mailing address

2575 COUNTY ROAD 220 SUITE 103
MIDDLEBURG FL
32068-6550
US

V. Phone/Fax

Practice location:
  • Phone: 904-213-1776
  • Fax: 904-298-3698
Mailing address:
  • Phone: 904-213-1776
  • Fax: 904-298-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME36954
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD E WOOD
Title or Position: PRIMARY DOCTOR
Credential: M.D.
Phone: 904-213-1776