Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | L5613 | TX |
NPI | 1023127701 |
---|---|
Provider Name | Andrew Lawrence Whaley |
First Address | Houston, TX 77210-4639 |
Second Address | San Antonio, TX 78209-2651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 17/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
157921104 | (05) | TX |
157921106 | (05) | TX |
6509510001 | MEDICARE DME PTAN (01) | TX |
G74031 | (02) | TX |
TXB103513 | MEDICARE GROUP PTAN (01) | TX |