Healthcare Provider Details

I. General information

NPI: 1740620251
Provider Name (Legal Business Name): DANIEL R WOOLERY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 S LAFAYETTE AVE
SEDALIA MO
65301-7542
US

IV. Provider business mailing address

601 E 14TH ST
SEDALIA MO
65301-5972
US

V. Phone/Fax

Practice location:
  • Phone: 660-827-7990
  • Fax: 660-827-7683
Mailing address:
  • Phone: 660-829-7744
  • Fax: 660-827-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2016011146
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2016011146
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: