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General NPI Number Information
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NPI Number | 1770676090
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Entity Type | Individual
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Provider Name | MARK S WOOD M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 598 W 11TH AVE
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City | LUMBERTON
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State | MS
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Zip | 39455
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Country | US
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Telephone | 601-796-4214
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Fax | 601-796-9437
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Provider Business Mailing Address
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Address Line | PO BOX 1729
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City | HATTIESBURG
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State | MS
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Zip | 39403-1729
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Country | US
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Telephone | 601-545-8700
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Fax | 601-450-0231
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 19048
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License Number State | MS
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