Basic Information
| Provider Information | |||||||||
| NPI: | 1790932903 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHALEY JR | ||||||||
| FirstName: | SIDNEY | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1019 PACIFIC AVE STE 300 | ||||||||
| Address2: | COMMUNITY HEALTH CARE | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537221540 | ||||||||
| FaxNumber: | 2537221546 | ||||||||
| Practice Location | |||||||||
| Address1: | 1708 E 44TH ST | ||||||||
| Address2: | COMMUNITY HEALTH CARE | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984044611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535974550 | ||||||||
| FaxNumber: | 2537221546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 10945 | WA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.