Healthcare Provider Details

I. General information

NPI: 1245285469
Provider Name (Legal Business Name): ELLEN WOOD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SW 62ND PL 4TH FLOOR
SOUTH MIAMI FL
33143-4806
US

IV. Provider business mailing address

7300 SW 62ND PL 4TH FLOOR
SOUTH MIAMI FL
33143-4806
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-7901
  • Fax: 305-662-7910
Mailing address:
  • Phone: 305-662-7901
  • Fax: 305-662-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberOS8232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: