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General NPI Number Information
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NPI Number | 1437403821
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Entity Type | Organization
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Legal Business Name | BRENT S WOOD DPM PLLC
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1502 BLUE RIDGE DR STE 104
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City | GEORGETOWN
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State | TX
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Zip | 78626-1002
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Country | US
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Telephone | 512-719-4545
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Fax | 512-372-3396
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Provider Business Mailing Address
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Address Line | 1502 BLUE RIDGE DR STE 104
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City | GEORGETOWN
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State | TX
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Zip | 78626-1002
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Country | US
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Telephone | 512-719-4545
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Fax | 512-372-3396
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. BRENT WOOD
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Credential | D.P.M.
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Telephone | 512-719-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 1890
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License Number State | TX
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