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General NPI Number Information
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NPI Number | 1215983770
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Entity Type | Organization
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Legal Business Name | DPMWOLERYPROH LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 818 GAY ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4119
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Country | US
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Telephone | 740-355-3095
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Fax | 740-355-3935
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Provider Business Mailing Address
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Address Line | 818 GAY ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4119
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Country | US
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Telephone | 740-355-3095
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Fax | 740-355-3935
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM M WOLERY
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Credential | DPM
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Telephone | 740-355-3095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 36.001607
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License Number State | OH
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