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General NPI Number Information
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NPI Number | 1265445845
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Entity Type | Organization
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Legal Business Name | JERRY L. WOOLUM, M.D., P.S.C.
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 121 VIRGINIA AVENUE SUITE F200
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City | PINEVILLE
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State | KY
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Zip | 40977
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Country | US
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Telephone | 606-337-0860
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Fax | 606-337-9956
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Provider Business Mailing Address
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Address Line | 121 VIRGINIA AVENUE SUITE F200
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City | PINEVILLE
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State | KY
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Zip | 40977
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Country | US
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Telephone | 606-337-0860
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Fax | 606-337-9956
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Authorized Official
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Title or Position | MD
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Name | MR. JERRY L WOOLUM
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Credential | MD
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Telephone | 606-337-0860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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