Provider Demographics
NPI:1669606414
Name:WOOD, BRENT S (DPM)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:S
Last Name:WOOD
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1502 BLUE RIDGE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-1002
Mailing Address - Country:US
Mailing Address - Phone:512-719-4545
Mailing Address - Fax:512-372-3396
Practice Address - Street 1:1502 BLUE RIDGE DR STE 104
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-1002
Practice Address - Country:US
Practice Address - Phone:512-719-4545
Practice Address - Fax:512-372-3396
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1890213ES0000X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine