Provider Demographics
NPI:1760589733
Name:WOOD, MARK W (MD)
Entity Type:Individual
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First Name:MARK
Middle Name:W
Last Name:WOOD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3033 NW 63RD ST STE 152E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3607
Mailing Address - Country:US
Mailing Address - Phone:405-755-6651
Mailing Address - Fax:405-755-2795
Practice Address - Street 1:3824 S BOULEVARD STE 160
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-607-7600
Practice Address - Fax:405-607-3575
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-05-15
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Provider Licenses
StateLicense IDTaxonomies
OK17414207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100107680AMedicaid