Provider Demographics
NPI:1730141367
Name:WOOLARD, DOUGLAS WINFIELD (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WINFIELD
Last Name:WOOLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 FRONT AVENUE
Mailing Address - Street 2:SUITE #502
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-415-0524
Mailing Address - Fax:208-763-3644
Practice Address - Street 1:601 FRONT AVENUE
Practice Address - Street 2:SUITE #502
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-415-0524
Practice Address - Fax:208-763-3644
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010382352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology