Provider Demographics
NPI:1528123874
Name:WOOD, JAMES OTHA JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:OTHA
Last Name:WOOD
Suffix:JR
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 1:303 N RODEO DR
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:OK
Mailing Address - Zip Code:73529-1423
Mailing Address - Country:US
Mailing Address - Phone:580-439-6889
Mailing Address - Fax:580-439-8012
Practice Address - Street 1:303 N RODEO DR
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:OK
Practice Address - Zip Code:73529-1423
Practice Address - Country:US
Practice Address - Phone:580-439-6889
Practice Address - Fax:580-439-8012
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1108121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100255620BMedicaid
OK100255620COtherSOONERCARE
OK080104988OtherRAILROAD MEDICARE
OK200135670AMedicaid
OK100255620DOtherO-EPIC
OK200135670AMedicaid
OK080104988OtherRAILROAD MEDICARE
OK100255620BMedicaid