Provider Demographics
NPI:1225003114
Name:RICHARD E WOOD, M.D.
Entity Type:Organization
Organization Name:RICHARD E WOOD, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-213-1776
Mailing Address - Street 1:2575 COUNTY ROAD 220
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6550
Mailing Address - Country:US
Mailing Address - Phone:904-213-1776
Mailing Address - Fax:904-298-3698
Practice Address - Street 1:2575 COUNTY ROAD 220
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-6550
Practice Address - Country:US
Practice Address - Phone:904-213-1776
Practice Address - Fax:904-298-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7047637OtherCLARENDON HEALTHY KIDS
FL15575OtherBLUE CROSS BLUE SHIELD
FL15575Medicare ID - Type Unspecified
FLD61792Medicare UPIN