MEDICARE: DR. LANCE DEWEY WHALEY 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	174400000X	Specialist	06684	MS

General Provider Information

NPI Number	:	1760437875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANCE DEWEY WHALEY MD

Provider Business Mailing Address
First Line	:	116 S MAIN ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1721
Country	:	US
Telephone Number	:	662-487-1605
Fax Number	:	662-487-9068

Provider Business Practice Location Address
First Line	:	116 S MAIN ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1721
Country	:	US
Telephone Number	:	662-487-1605
Fax Number	:	662-487-9068

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/20/2014

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Directions to “ DR. LANCE DEWEY WHALEY MD” Practice Location

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