Basic Information
| Provider Information | |||||||||
| NPI: | 1356339832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | BEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16811 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816904678 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16811 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816904678 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 08/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | J6820 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | J6820 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 145723601 | 05 | TX | MEDICAID | 2122274 | 05 | LA | MEDICAID | 145723604 | 05 | TX | MEDICAID | P01055728 | 01 | TX | RR MEDICARE | OTHER | 145723606 | 05 | TX | MEDICAID | P00663449 | 01 | TX | MEDICARE RAILROAD | OTHER | 145723605 | 05 | TX | MEDICAID | 8BP170 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 145723602 | 05 | TX | MEDICAID | 610119705 | 01 | TX | US DEPT OF LABOR | OTHER | 145723603 | 05 | TX | MEDICAID |