Healthcare Provider Details

I. General information

NPI: 1932744158
Provider Name (Legal Business Name): BRIAN J WHIPPO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO MSC 10-8000
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5062
  • Fax: 505-925-7290
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2019-0102
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: