MEDICARE: DR. MALISSA J WOOD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	70796	MA
2	207RC0000X	Cardiovascular Disease Physician	70796	MA
3	207RC0000X	Cardiovascular Disease Physician	ME128089	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J22884	OTHER	MA	BCBS MA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	070796	OTHER	MA	TUFTS HEALTH PLAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154312056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALISSA J WOOD MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-6350
Fax Number	:	239-343-4738

Provider Business Practice Location Address
First Line	:	9800 S HEALTHPARK DR STE 320
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-3630
Country	:	US
Telephone Number	:	239-343-6350
Fax Number	:	239-343-4738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	08/02/2023

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Directions to “ DR. MALISSA J WOOD MD” Practice Location

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