Healthcare Provider Details

I. General information

NPI: 1891087730
Provider Name (Legal Business Name): MR. JON S WOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 FORUM BLVD SUITE 2
COLUMBIA MO
65203-5451
US

IV. Provider business mailing address

6 VICTORY DR SUITE 8
LIBERTY MO
64068-2395
US

V. Phone/Fax

Practice location:
  • Phone: 573-256-4232
  • Fax:
Mailing address:
  • Phone: 816-313-2800
  • Fax: 816-792-9819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2008000939
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: