Provider Demographics
NPI:1093729253
Name:WOOLAM, GERALD LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LYNN
Last Name:WOOLAM
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 1:3611 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1317
Mailing Address - Country:US
Mailing Address - Phone:806-771-2222
Mailing Address - Fax:806-771-2224
Practice Address - Street 1:3611 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1317
Practice Address - Country:US
Practice Address - Phone:806-771-2222
Practice Address - Fax:806-771-2224
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0355208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD0355OtherLICENSE
TXB27670Medicare UPIN
TXD0355OtherLICENSE