Provider Demographics
NPI:1679579015
Name:WOOLVERTON, WILLIAM SCOTT (MDFACC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCOTT
Last Name:WOOLVERTON
Suffix:
Gender:F
Credentials:MDFACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 VENETIA BAY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-8046
Mailing Address - Country:US
Mailing Address - Phone:941-497-5511
Mailing Address - Fax:941-492-2221
Practice Address - Street 1:901 VENETIA BAY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-8046
Practice Address - Country:US
Practice Address - Phone:941-497-5511
Practice Address - Fax:941-492-2221
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252635200Medicaid
FL43215Medicare ID - Type Unspecified
FLG58878Medicare UPIN