Provider Demographics
NPI:1639516149
Name:WHISLER, DONALD LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LLOYD
Last Name:WHISLER
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 1:1162 MONTGOMERY DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4802
Mailing Address - Country:US
Mailing Address - Phone:707-890-4250
Mailing Address - Fax:707-476-2238
Practice Address - Street 1:1162 MONTGOMERY DR STE 3
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4802
Practice Address - Country:US
Practice Address - Phone:707-890-4250
Practice Address - Fax:707-476-2238
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA155450207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program