Provider Demographics
NPI:1659406072
Name:WOOD, LARRY KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:KEITH
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 1:109 S. PARK DR.
Mailing Address - Street 2:CRB MEDICAL ASSOCIATES
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801
Mailing Address - Country:US
Mailing Address - Phone:325-641-2907
Mailing Address - Fax:325-641-1088
Practice Address - Street 1:109 S. PARK DR.
Practice Address - Street 2:CRB MEDICAL ASSOCIATES
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801
Practice Address - Country:US
Practice Address - Phone:325-641-2907
Practice Address - Fax:325-641-1088
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013038718207W00000X
TXH8526207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034388102Medicaid
TX034388102Medicaid
TXF53418Medicare UPIN