Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 056034 | NY |
Y | 213EG0000X | General Practice | 056034 | NY |
NPI | 1003102203 |
---|---|
Provider Name | Dr. Matthew Richard Whipple |
First Address | Amherst, NY 14226-3313 |
Second Address | East Aurora, NY 14052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2011 |
Last Update Date | 11/07/2012 |