Provider Demographics
NPI:1437442597
Name:WOOD, JOHN RALPH (DPH)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RALPH
Last Name:WOOD
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3525
Mailing Address - Country:US
Mailing Address - Phone:606-676-0485
Mailing Address - Fax:606-676-9625
Practice Address - Street 1:1250 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3525
Practice Address - Country:US
Practice Address - Phone:606-676-0485
Practice Address - Fax:606-676-9625
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0062381835G0303X
FLPS118281835G0303X
TN00000045741835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric