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General NPI Number Information
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NPI Number | 1760437875
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Entity Type | Individual
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Provider Name | LANCE DEWEY WHALEY MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 116 S MAIN ST
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City | SARDIS
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State | MS
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Zip | 38666-1721
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Country | US
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Telephone | 662-487-1605
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Fax | 662-487-9068
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Provider Business Mailing Address
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Address Line | 116 S MAIN ST
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City | SARDIS
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State | MS
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Zip | 38666-1721
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Country | US
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Telephone | 662-487-1605
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Fax | 662-487-9068
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 06684
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License Number State | MS
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