Provider Demographics
NPI:1437403821
Name:BRENT S WOOD DPM PLLC
Entity Type:Organization
Organization Name:BRENT S WOOD DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-719-4545
Mailing Address - Street 1:10601 PECAN PARK BLVD STE 301-B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1448
Mailing Address - Country:US
Mailing Address - Phone:512-719-4545
Mailing Address - Fax:512-372-3396
Practice Address - Street 1:10601 PECAN PARK BLVD STE 301-B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1448
Practice Address - Country:US
Practice Address - Phone:512-719-4545
Practice Address - Fax:512-372-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1890261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437403821OtherNPI,BUSINESS
1669606414OtherNPI, INDIVIDUAL