Provider Demographics
NPI:1669429031
Name:WOOD, JUDSON BOOKER (MD)
Entity type:Individual
Prefix:
First Name:JUDSON
Middle Name:BOOKER
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 1:200 E 89TH AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7318
Mailing Address - Country:US
Mailing Address - Phone:219-757-7566
Mailing Address - Fax:219-757-7253
Practice Address - Street 1:200 E 89TH AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7318
Practice Address - Country:US
Practice Address - Phone:219-757-7566
Practice Address - Fax:219-757-7253
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86413207X00000X
IN01042172207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272498700Medicaid
FLP00293501OtherRR MEDICARE
FL16016Z - TAMPAMedicare PIN
FLF67766Medicare UPIN
FL16016Y - PASCOMedicare PIN