Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 33020 | CO |
N | 207ND0101X | MOHS-Micrographic Surgeon | 33020 | CO |
N | 207NS0135X | Procedural Dermatology | 33020 | CO |
NPI | 1336186246 |
---|---|
Provider Name | Kevin L Whaley |
First Address | Colorado Springs, CO 80920 |
Second Address | Colorado Springs, CO 80920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G18964 | (02) |