Provider Demographics
NPI:1144339375
Name:EDWIN C. WOOD, M.D., P.A.
Entity type:Organization
Organization Name:EDWIN C. WOOD, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-667-1830
Mailing Address - Street 1:3642 UNIVERSITY BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3360
Mailing Address - Country:US
Mailing Address - Phone:713-667-1830
Mailing Address - Fax:713-520-8139
Practice Address - Street 1:3642 UNIVERSITY BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-3360
Practice Address - Country:US
Practice Address - Phone:713-667-1830
Practice Address - Fax:713-520-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0195261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE81020Medicare UPIN
TX83020JMedicare ID - Type UnspecifiedINDIVIDUAL