Healthcare Provider Details

I. General information

NPI: 1760589733
Provider Name (Legal Business Name): MARK W. WOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/15/2023
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 S BOULEVARD STE 160
EDMOND OK
73013
US

IV. Provider business mailing address

3033 NW 63RD ST STE 152E
OKLAHOMA CITY OK
73116-3607
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-7600
  • Fax: 405-607-3575
Mailing address:
  • Phone: 405-755-6651
  • Fax: 405-755-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number17414
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: