Individual
LAVON JENEEN WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. D.
Contact information
Practice address
108 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
(479) 968-7170
(479) 890-2467
Mailing address
108 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
(479) 968-7170
(479) 890-2467
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-6054
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183739001
—
AR
Enumeration date
06/06/2007
Last updated
03/10/2017
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