Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 10041 | MS |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 10041 | MS |
NPI | 1174577944 |
---|---|
Provider Name | Dr. John R Wooley |
First Address | Jackson, MS 39202-1867 |
Second Address | Jackson, MS 39202-1687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 19/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015896 | (05) | MS |
B31084 | (02) |