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General NPI Number Information
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NPI Number | 1023544830
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Entity Type | Individual
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Provider Name | CHANEL WOOD MD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 1 SHIRCLIFF WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4748
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Country | US
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Telephone | 904-308-7300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 161180
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-1180
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Country | US
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Telephone | 904-388-6949
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Fax | 904-388-1841
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME137496
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TRN24856
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License Number State | FL
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