Healthcare Provider Details

I. General information

NPI: 1649579996
Provider Name (Legal Business Name): STEPHEN ALEXANDER WHELESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 20TH ST SUITE 204
KNOXVILLE TN
37916-1809
US

IV. Provider business mailing address

501 20TH ST SUITE 204
KNOXVILLE TN
37916-1809
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-5477
  • Fax:
Mailing address:
  • Phone: 865-546-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD0000053384
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: