Provider Demographics
NPI:1801831805
Name:WOOD, RAYMOND ALOYSIUS JR (DO)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ALOYSIUS
Last Name:WOOD
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E H ST
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4760
Mailing Address - Country:US
Mailing Address - Phone:906-774-3300
Mailing Address - Fax:906-779-3166
Practice Address - Street 1:325 E H ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4760
Practice Address - Country:US
Practice Address - Phone:906-774-3300
Practice Address - Fax:906-779-3166
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012252207RC0000X
MI6315144653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34966400Medicaid
060044344OtherRAILROAD MEDICARE
MI3352150Medicaid
MI0655200075OtherBLUE CROSS BLUE SHIELD
MI3352150Medicaid
MI0655200075OtherBLUE CROSS BLUE SHIELD
0C16002Medicare PIN