Healthcare Provider Details

I. General information

NPI: 1669606414
Provider Name (Legal Business Name): BRENT S WOOD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 BLUE RIDGE DR STE 104
GEORGETOWN TX
78626-1002
US

IV. Provider business mailing address

1502 BLUE RIDGE DR STE 104
GEORGETOWN TX
78626-1002
US

V. Phone/Fax

Practice location:
  • Phone: 512-719-4545
  • Fax: 512-372-3396
Mailing address:
  • Phone: 512-719-4545
  • Fax: 512-372-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number1890
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1890
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1890
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: