Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A53446 | CA |
N | 111NI0900X | Internist | A53446 | CA |
Y | 2080P0216X | Pediatric Rheumatologist | A53446 | CA |
NPI | 1083681258 |
---|---|
Provider Name | Dr. John Patrick Whelan |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-1249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150043 | TUFTS HEALTH PLAN (01) | MA |
3204120 | (05) | MA |
H09126 | (02) | |
J21870 | BCBS MA (01) | MA |