Provider Demographics
NPI:1194822817
Name:WOOD, ROBERT LAMONT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAMONT
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 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:270-825-6680
Mailing Address - Fax:270-825-7266
Practice Address - Street 1:200 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:270-825-6680
Practice Address - Fax:270-825-7266
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY24125OtherLICENSE
KY64241250Medicaid
000000044295OtherBCBS PROVIDER NUMBER
0375310Medicare PIN
KY080155241Medicare PIN
KY64241250Medicaid
0374709Medicare PIN
0376126Medicare PIN
KY00280134Medicare PIN
000000044295OtherBCBS PROVIDER NUMBER
0375211Medicare PIN
0374609Medicare PIN