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Individual

DR. MARK S WOOD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
598 W 11TH AVE, LUMBERTON, MS 39455
(601) 796-4214
(601) 796-9437
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-8700
(601) 450-0231

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
19048
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12450126
CAQH NUMBER
MS
01
873790
MS MEDICARE PROVIDER NUMBER
MS
Enumeration date
09/30/2006
Last updated
11/12/2019
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