Provider Demographics
NPI:1477784791
Name:C.TODD WOOLLEY MD PC
Entity Type:Organization
Organization Name:C.TODD WOOLLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-274-4865
Mailing Address - Street 1:2222 NW LOVEJOY ST STE 401
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5102
Mailing Address - Country:US
Mailing Address - Phone:503-274-4865
Mailing Address - Fax:503-274-4989
Practice Address - Street 1:2222 NW LOVEJOY ST STE 401
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5102
Practice Address - Country:US
Practice Address - Phone:503-274-4865
Practice Address - Fax:503-274-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23565207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty