Provider Demographics
NPI:1235424680
Name:WOODS, JACOB TENNYSON (DO)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:TENNYSON
Last Name:WOODS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10120 E OLD VAIL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-9414
Mailing Address - Country:US
Mailing Address - Phone:520-989-8012
Mailing Address - Fax:520-959-8014
Practice Address - Street 1:10120 E OLD VAIL RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9414
Practice Address - Country:US
Practice Address - Phone:520-989-8012
Practice Address - Fax:520-959-8014
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZR1921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine