Provider Demographics
NPI:1255127122
Name:WHALEY, ROBERT III
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WHALEY
Suffix:III
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 COAST GUARD DR
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-2048
Mailing Address - Country:US
Mailing Address - Phone:231-597-2030
Mailing Address - Fax:
Practice Address - Street 1:632 COAST GUARD DR
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2048
Practice Address - Country:US
Practice Address - Phone:231-597-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman