MEDICARE: DR. SEAN PATRICK WHERRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider
2	207Q00000X	Family Medicine Physician	108778	MN

General Provider Information

NPI Number	:	1407948458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN PATRICK WHERRY MD

Provider Business Mailing Address
First Line	:	1360 ELM STREET EAST
Second Line	:	CENTRACARE CLINIC ST JOSEPH FAMILY MEDICINE
City	:	ST JOSEPH
State	:	MN
Zip	:	56374-4694
Country	:	US
Telephone Number	:	320-363-7765
Fax Number	:	320-363-0031

Provider Business Practice Location Address
First Line	:	1360 ELM STREET EAST
Second Line	:	CENTRACARE CLINIC ST JOSEPH FAMILY MEDICINE
City	:	ST JOSEPH
State	:	MN
Zip	:	56374-4694
Country	:	US
Telephone Number	:	320-363-7765
Fax Number	:	320-363-0031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	03/16/2023

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