Provider Demographics
NPI:1023127701
Name:WHALEY, ANDREW LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LAWRENCE
Last Name:WHALEY
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 1:250 W SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2651
Mailing Address - Country:US
Mailing Address - Phone:210-293-2663
Mailing Address - Fax:210-293-2719
Practice Address - Street 1:250 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2651
Practice Address - Country:US
Practice Address - Phone:210-293-2663
Practice Address - Fax:210-293-2719
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5613207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157921104Medicaid
TXTXB103513OtherMEDICARE GROUP PTAN
TX157921106Medicaid
TX6509510001OtherMEDICARE DME PTAN
TX157921104Medicaid