Healthcare Provider Details

I. General information

NPI: 1134120645
Provider Name (Legal Business Name): THOMAS JOSEPH WHALEN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 CANDELARIA RD NE STE K
ALBUQUERQUE NM
87107-1952
US

IV. Provider business mailing address

3311 CANDELARIA RD NE STE K
ALBUQUERQUE NM
87107-1952
US

V. Phone/Fax

Practice location:
  • Phone: 505-246-9190
  • Fax: 505-896-9461
Mailing address:
  • Phone: 505-246-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number97165
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: