Provider Demographics
NPI:1619944188
Name:WOOD, AMY COREEN (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:COREEN
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 1:7515 MAIN ST
Mailing Address - Street 2:SUITE 770
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4537
Mailing Address - Country:US
Mailing Address - Phone:713-797-6171
Mailing Address - Fax:713-797-6669
Practice Address - Street 1:7515 MAIN ST
Practice Address - Street 2:SUITE 770
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4537
Practice Address - Country:US
Practice Address - Phone:713-797-6171
Practice Address - Fax:713-797-6669
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21917Medicare PIN
TX8K1135Medicare PIN
TX8F23900Medicare PIN