Provider Demographics
NPI:1528196037
Name:WOOD, BETTY L (MD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:WOOD
Suffix:
Gender:F
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:PO BOX 8422
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33738-8422
Mailing Address - Country:US
Mailing Address - Phone:727-399-1715
Mailing Address - Fax:727-399-1715
Practice Address - Street 1:7130 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5935
Practice Address - Country:US
Practice Address - Phone:727-399-1715
Practice Address - Fax:727-399-1715
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4967103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59455Medicare ID - Type UnspecifiedFL MEDICARE