Healthcare Provider Details

I. General information

NPI: 1164513099
Provider Name (Legal Business Name): DAVID CHRIS WOOD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77-6403 NALANI ST STE 104
KAILUA KONA HI
96740-9763
US

IV. Provider business mailing address

PO BOX 2148
KAILUA KONA HI
96745-2148
US

V. Phone/Fax

Practice location:
  • Phone: 808-300-8606
  • Fax: 808-657-6833
Mailing address:
  • Phone: 808-300-8606
  • Fax: 808-657-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO-208
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberWV342
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: