Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 200001448 | NC |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 200001448 | NC |
NPI | 1134172372 |
---|---|
Provider Name | Dr. Mark Lyndon Wood |
First Address | Raleigh, NC 27604-0010 |
Second Address | Raleigh, NC 27610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 15/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
891371CJ | (05) | NC |
I13273 | (02) |