Provider Demographics
NPI:1164513099
Name:WOOD, DAVID CHRIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRIS
Last Name:WOOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2148
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-2148
Mailing Address - Country:US
Mailing Address - Phone:808-300-8606
Mailing Address - Fax:808-657-6833
Practice Address - Street 1:77-6403 NALANI ST STE 104
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9763
Practice Address - Country:US
Practice Address - Phone:808-300-8606
Practice Address - Fax:808-657-6833
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-208213E00000X
WVWV342213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0100096000Medicaid
0858273Medicare PIN
4461740001Medicare NSC
WV0858272Medicare ID - Type Unspecified
480032209Medicare PIN
U72131Medicare UPIN