Provider Demographics
NPI:1225037757
Name:WOOLLEY, JAMES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:WOOLLEY
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 1:6 WOODLAND ROAD.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ST. HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9554
Mailing Address - Country:US
Mailing Address - Phone:707-963-1031
Mailing Address - Fax:916-678-6762
Practice Address - Street 1:6 WOODLAND ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:ST. HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9554
Practice Address - Country:US
Practice Address - Phone:707-963-1031
Practice Address - Fax:707-963-3487
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2013-06-17
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAG45484174400000X, 208800000X
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G454841Medicaid
CA00G454841Medicaid
CAA50062Medicare UPIN