Healthcare Provider Details

I. General information

NPI: 1225037757
Provider Name (Legal Business Name): JAMES L WOOLLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date: 03/18/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

6 WOODLAND ROAD SUITE 104
ST. HELENA CA
94574-9554
US

IV. Provider business mailing address

6 WOODLAND ROAD. SUITE 104
ST. HELENA CA
94574-9554
US

V. Phone/Fax

Practice location:
  • Phone: 707-963-1031
  • Fax: 707-963-3487
Mailing address:
  • Phone: 707-963-1031
  • Fax: 916-678-6762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG45484
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG45484
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: