NPIMap

Organization Active NPI

Sidney F Whaley Jr

  • Dermatology Physician
  • Tacoma, WA
National Provider Identifier
1336129154
Registry record updated Oct 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
10945 Issued in WA
Legal business name
SIDNEY F WHALEY JR
Practice address
314 MLK Jr Wy #210
Tacoma, WA 98405-4271
Phone
(253) 383-1529
Fax
(253) 593-4344
NPI assigned
Jan 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Sidney F Whaley Jr., MD
Title
President
Phone
(253) 383-1529

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X 10945 WA Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X 10945 WA
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X 10945 WA

Addresses

Primary practice location

314 MLK Jr Wy #210
Tacoma, WA 98405-4271

Mailing address

314 MLK Jr Wy #210
Tacoma, WA 98405-4271
Phone (253) 383-1529

Other identifiers 2

IdentifierTypeStateIssuer
1930007MedicaidWA
WH4111OtherREGENCE

National Provider Directory

National Provider Directory

Locations

314 Martin Luther King Jr Way
Ste 210
Tacoma, WA 98405
Phone (253) 383-1529

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1336129154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 MLK JR WY #210",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054271",
            "telephone_number": "253-383-1529",
            "fax_number": "253-593-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 MLK JR WY #210",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054271",
            "telephone_number": "253-383-1529",
            "fax_number": "253-593-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDNEY F WHALEY JR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "WHALEY",
        "authorized_official_first_name": "SIDNEY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-383-1529",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "WA",
            "license": "10945",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "WA",
            "license": "10945",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "WA",
            "license": "10945",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1930007",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "WH4111",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.