Healthcare Provider Details

I. General information

NPI: 1790162063
Provider Name (Legal Business Name): JOSEPH C WOOLLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 07/08/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

2108 E THOMAS RD STE 130
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0940
  • Fax: 602-933-2468
Mailing address:
  • Phone: 602-933-3124
  • Fax: 602-933-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number009592
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: