MEDICARE: DR. CALEN WHERRY M.D

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	2083X0100X	Occupational Medicine Physician	MD.201313	LA
2	2083A0100X	Aerospace Medicine Physician	MD.201313	LA

General Provider Information

NPI Number	:	1497976294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALEN WHERRY M.D

Provider Business Mailing Address
First Line	:	355TH MEDICAL GROUP
Second Line	:	4175 S. ALAMO AVENUE
City	:	DAVIS-MONTHAN AFB
State	:	AZ
Zip	:	85707-4405
Country	:	US
Telephone Number	:	520-228-2615
Fax Number	:	520-228-2627

Provider Business Practice Location Address
First Line	:	355TH MEDICAL GROUP
Second Line	:	280 FIRST STREET, BLDG 23
City	:	DAVIS MONTHAN AFB
State	:	AZ
Zip	:	85707-4405
Country	:	US
Telephone Number	:	520-228-2615
Fax Number	:	520-228-2627

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	11/02/2018

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