Healthcare Provider Details

I. General information

NPI: 1437403821
Provider Name (Legal Business Name): BRENT S WOOD DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
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 TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number1890
License Number StateTX

VIII. Authorized Official

Name: DR. BRENT WOOD
Title or Position: OWNER/MANAGER
Credential: D.P.M.
Phone: 512-719-4545