Healthcare Provider Details

I. General information

NPI: 1740113414
Provider Name (Legal Business Name): MELANIE WOOD MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6903 BIG BEND DR
IDAHO FALLS ID
83406-5501
US

IV. Provider business mailing address

6903 BIG BEND DR
IDAHO FALLS ID
83406-5501
US

V. Phone/Fax

Practice location:
  • Phone: 203-499-7998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELANIE WOOD
Title or Position: DIRECTOR
Credential: MD
Phone: 203-499-7998