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Individual

JACOB MYLES WOOD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
8595 PICARDY AVE STE 100, BATON ROUGE, LA 70809-3674
(225) 763-4900
(225) 763-4066
Mailing address
8595 PICARDY AVE STE 100, BATON ROUGE, LA 70809-3674
(225) 763-4900
(225) 763-4066

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
00024312
AL
207Q00000X
Family Medicine Physician
Primary
202160
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
051522945
AL
05
1319368
LA
05
1328201
LA
05
1347957
LA
01
51522945
BLUE CROSS BLUE SHIELD
AL
01
H51432
VIVA HEALTH
AL
01
P00141370
RAIL ROAD MEDICARE
Enumeration date
02/07/2006
Last updated
12/13/2018
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