Provider Demographics
NPI:1013956572
Name:WOOLERY, WILLIAM ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALAN
Last Name:WOOLERY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11111 PANAMA CITY BEACH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413
Mailing Address - Country:US
Mailing Address - Phone:850-475-4500
Mailing Address - Fax:850-475-4781
Practice Address - Street 1:11111 PANAMA CITY BEACH PARKWAY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413
Practice Address - Country:US
Practice Address - Phone:850-770-3270
Practice Address - Fax:850-770-3275
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029974207P00000X
GA29974207Q00000X
FLOS11952207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00369091AMedicaid
GA00369091AMedicaid
GA11SCFXVMedicare ID - Type UnspecifiedPROVIDER NUMBER