Provider Demographics
NPI:1760475974
Name:WOOD, SAMUEL T (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:T
Last Name:WOOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 771470
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63177-2470
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:
Practice Address - Street 1:662 SAINT FERDINAND ST
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5125
Practice Address - Country:US
Practice Address - Phone:314-921-1020
Practice Address - Fax:314-921-2450
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000820213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO304708514Medicaid
MO260535265Medicare PIN
MOU64775Medicare UPIN