Provider Demographics
NPI:1902822976
Name:WOOD, JOHN BRIAN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRIAN THOMAS
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1141 NORTH ROAD STREET
Mailing Address - Street 2:STE K
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-331-7600
Mailing Address - Fax:252-331-7730
Practice Address - Street 1:1141 NORTH ROAD STREET
Practice Address - Street 2:STE K
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-331-7600
Practice Address - Fax:252-331-7730
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC39141207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8988911Medicaid
NC8988911Medicaid
F05628Medicare UPIN