Provider Demographics
NPI:1104995109
Name:WOOLLEY, ROBERT BROWN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BROWN
Last Name:WOOLLEY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:801-377-2810
Practice Address - Street 1:1055 N 300 W STE 210
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3374
Practice Address - Country:US
Practice Address - Phone:801-357-0280
Practice Address - Fax:801-377-2810
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057426A207RN0300X, 2083A0100X
UT269743-1205207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine