Provider Demographics
NPI:1598714909
Name:WOOD, JEREMY JAKOB (MD)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:JAKOB
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-766-7441
Mailing Address - Fax:
Practice Address - Street 1:470 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4858
Practice Address - Country:US
Practice Address - Phone:301-668-2020
Practice Address - Fax:301-620-8729
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0097046207W00000X
VA0101240205207W00000X
LA25642207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA33584OtherCDS
VA0101240205OtherSTATE LICENSE
LA1045926Medicaid
LA25642OtherSTATE MEDICAL LICENSE
LA25642OtherSTATE MEDICAL LICENSE
LA33584OtherCDS
VA541958817OtherTIN
LA25642OtherSTATE MEDICAL LICENSE
LA33584OtherCDS
LA1045926Medicaid