Provider Demographics
NPI:1356339832
Name:WOOD, JEFFREY BEN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BEN
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4728
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6820207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145723601Medicaid
LA2122274Medicaid
TX145723604Medicaid
TXP01055728OtherRR MEDICARE
TX145723606Medicaid
TXP00663449OtherMEDICARE RAILROAD
TX145723605Medicaid
TX8BP170OtherBLUE CROSS BLUE SHIELD
TX145723602Medicaid
TX610119705OtherUS DEPT OF LABOR
TX145723603Medicaid
G98445Medicare UPIN
TX145723606Medicaid
TX8L13564Medicare PIN
TX8L5882Medicare PIN
TXP00663449OtherMEDICARE RAILROAD
TX145723602Medicaid
TXTXB151348Medicare PIN
TXTXB151347Medicare PIN