Provider Demographics
NPI:1013948892
Name:WOOD, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:111 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5622
Practice Address - Country:US
Practice Address - Phone:864-797-7150
Practice Address - Fax:864-797-7155
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12848207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC128481Medicaid
SC576007863158OtherBCBS OF SC ID
SCP002713367OtherRR MEDICARE
SC576007863130OtherBLUECHOICE HEALTHPLAN ID
SC9455844OtherCIGNA ID
SC4262977OtherAETNA ID
SC128481Medicaid
SCD175928299Medicare PIN
SC4262977OtherAETNA ID