Healthcare Provider Details

I. General information

NPI: 1174207427
Provider Name (Legal Business Name): JONATHAN WOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986155 NEBRASKA MEDICAL CTR
OMAHA NE
68198-6155
US

IV. Provider business mailing address

986155 NEBRASKA MEDICAL CTR
OMAHA NE
68198-6155
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-3965
  • Fax:
Mailing address:
  • Phone: 402-559-3965
  • Fax: 402-552-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36514
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number36514
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: