# WOOD MD PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447775192
- **Authorized official:** LAVON JENEEN WOOD MD (PRESIDEN)
- **Authorized official phone:** (479) 219-5008

## Contact information

- **Practice address:** 1605 W MAIN ST, RUSSELLVILLE, AR 72801-2719
- **Practice address phone:** (479) 219-5008
- **Practice address fax:** (479) 219-5028
- **Mailing address:** 1605 W MAIN ST, RUSSELLVILLE, AR 72801-2719
- **Mailing address phone:** (479) 219-5008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/03/2017
- **Last updated:** 07/25/2022