Provider Demographics
NPI:1689029977
Name:WHALEY, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:WHALEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6437 SOUTHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2109
Mailing Address - Country:US
Mailing Address - Phone:903-275-5460
Mailing Address - Fax:214-481-9959
Practice Address - Street 1:6437 SOUTHPOINT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-2109
Practice Address - Country:US
Practice Address - Phone:903-275-5460
Practice Address - Fax:214-481-9959
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic