Basic Information
| Provider Information | |||||||||
| NPI: | 1013956572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOLERY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 11111 PANAMA CITY BEACH PARKWAY | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504754500 | ||||||||
| FaxNumber: | 8504754781 | ||||||||
| Practice Location | |||||||||
| Address1: | 11111 PANAMA CITY BEACH PARKWAY | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507703270 | ||||||||
| FaxNumber: | 8507703275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 10/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 029974 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 29974 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | OS11952 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207Q00000X | OS11952 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00369091A | 05 | GA | MEDICAID |