Healthcare Provider Details

I. General information

NPI: 1598754772
Provider Name (Legal Business Name): JAMES WILLIAM WHELAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 16TH ST
PUEBLO CO
81003-2745
US

IV. Provider business mailing address

412 ABISO AVE
SAN ANTONIO TX
78209-5107
US

V. Phone/Fax

Practice location:
  • Phone: 719-584-4045
  • Fax:
Mailing address:
  • Phone: 210-822-7136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01070742A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberCDRH.0053739
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20790
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: