Healthcare Provider Details

I. General information

NPI: 1205230414
Provider Name (Legal Business Name): ERIC L. WOOLLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ERIC WOOLLEY D.P.M.

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

IV. Provider business mailing address

401 9TH AVE NW
WATERTOWN SD
57201-1548
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-7000
  • Fax: 605-884-4332
Mailing address:
  • Phone: 605-882-7777
  • Fax: 605-884-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number234
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: