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General NPI Number Information
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NPI Number | 1922294032
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Entity Type | Organization
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Legal Business Name | JERRY D WOOD
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 219 NORTH EASTWOOD AVE
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City | LIVINGSTON
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State | TX
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Zip | 77351
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Country | US
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Telephone | 936-327-7147
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Fax | 936-327-6234
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Provider Business Mailing Address
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Address Line | 219 NORTH EASTWOOD AVE
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City | LIVINGSTON
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State | TX
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Zip | 77351
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Country | US
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Telephone | 936-327-7147
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Fax | 936-327-6234
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY D WOOD
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Credential | MD
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Telephone | 936-327-7147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G0304
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License Number State | TX
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