Provider Demographics
NPI:1619977683
Name:WHERRY, JEFFREY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:WHERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 CEDARWOOD LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6175
Mailing Address - Country:US
Mailing Address - Phone:925-460-9903
Mailing Address - Fax:925-460-9904
Practice Address - Street 1:1447 CEDARWOOD LN
Practice Address - Street 2:SUITE A
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6175
Practice Address - Country:US
Practice Address - Phone:925-460-9903
Practice Address - Fax:925-460-9904
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG810850Medicare ID - Type Unspecified
G64744Medicare UPIN