Provider Demographics
NPI:1962392753
Name:WOOLLEY, STEVEN (68W)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WOOLLEY
Suffix:
Gender:M
Credentials:68W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 COLUMBIA CIR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4268
Mailing Address - Country:US
Mailing Address - Phone:318-655-7869
Mailing Address - Fax:
Practice Address - Street 1:3820 WILLIAMS WAY
Practice Address - Street 2:232D MED BN E40-25
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:318-655-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty