Provider Demographics
NPI:1134127269
Name:WHERRY, PATRICK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:EDWARD
Last Name:WHERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4006
Mailing Address - Country:US
Mailing Address - Phone:408-356-7089
Mailing Address - Fax:408-356-0890
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:408-356-7089
Practice Address - Fax:408-356-0890
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA32798208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26933Medicare UPIN
CA00A327980Medicare ID - Type Unspecified