Healthcare Provider Details

I. General information

NPI: 1710923974
Provider Name (Legal Business Name): WILLIAM WOOSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR
LEXINGTON KY
40504-3742
US

IV. Provider business mailing address

2176 BROADHEAD PL
LEXINGTON KY
40515-1124
US

V. Phone/Fax

Practice location:
  • Phone: 859-313-1176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20682
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: