Provider Demographics
NPI:1760477475
Name:WOOLERY, WILLIAM G (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:WOOLERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1712 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7542
Mailing Address - Country:US
Mailing Address - Phone:660-827-2526
Mailing Address - Fax:660-827-5536
Practice Address - Street 1:1712 S LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7542
Practice Address - Country:US
Practice Address - Phone:660-827-2526
Practice Address - Fax:660-827-5536
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR1C99207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6484933Medicare PIN
E08059Medicare UPIN