Provider Demographics
NPI:1144212580
Name:WOOD, JAMES S (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4814
Mailing Address - Country:US
Mailing Address - Phone:801-262-2443
Mailing Address - Fax:801-262-8869
Practice Address - Street 1:4815 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4814
Practice Address - Country:US
Practice Address - Phone:801-262-2443
Practice Address - Fax:801-262-8869
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT161740-1205207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD20173Medicare UPIN
UT005539505Medicare PIN