Provider Demographics
NPI:1679566251
Name:WOOD, BETSY E (DO)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:E
Last Name:WOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:JONES
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1100 W STRYKER RD
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-7300
Mailing Address - Country:US
Mailing Address - Phone:863-453-7400
Mailing Address - Fax:863-452-1981
Practice Address - Street 1:1100 W STRYKER RD
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-7300
Practice Address - Country:US
Practice Address - Phone:863-453-7400
Practice Address - Fax:863-452-1981
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49958ZMedicare PIN
FL49958WMedicare PIN
FL49958YMedicare PIN
FL49958XMedicare PIN
G67085Medicare UPIN