Provider Demographics
NPI:1841495769
Name:WHITLEY, BRIAN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:WHITLEY
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 1:709 WICKER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4167
Mailing Address - Country:US
Mailing Address - Phone:919-775-3321
Mailing Address - Fax:919-774-1277
Practice Address - Street 1:709 WICKER ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4167
Practice Address - Country:US
Practice Address - Phone:919-775-3321
Practice Address - Fax:919-774-1277
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01419208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology