Provider Demographics
NPI:1659665289
Name:WOOD, ZACKERY SHANE (DO)
Entity Type:Individual
Prefix:DR
First Name:ZACKERY
Middle Name:SHANE
Last Name:WOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 LADERA DR
Mailing Address - Street 2:
Mailing Address - City:MARVIN
Mailing Address - State:NC
Mailing Address - Zip Code:28173-0043
Mailing Address - Country:US
Mailing Address - Phone:513-515-9225
Mailing Address - Fax:813-336-8376
Practice Address - Street 1:1012 LADERA DR
Practice Address - Street 2:
Practice Address - City:MARVIN
Practice Address - State:NC
Practice Address - Zip Code:28173-0043
Practice Address - Country:US
Practice Address - Phone:513-515-9225
Practice Address - Fax:813-336-8376
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-02888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine