Provider Demographics
NPI:1578570529
Name:WOOD, MARK GOFF (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GOFF
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 1:7075 N SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3329
Mailing Address - Country:US
Mailing Address - Phone:559-486-2000
Mailing Address - Fax:
Practice Address - Street 1:7075 N SHARON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3329
Practice Address - Country:US
Practice Address - Phone:559-486-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-161207W00000X
CAG27304207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G273040Medicaid
NMA43311Medicare UPIN