Provider Demographics
NPI:1871533158
Name:WHELAN W. CULLEY III MD PA
Entity type:Organization
Organization Name:WHELAN W. CULLEY III MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CULLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:727-398-5295
Mailing Address - Street 1:8211- 113 STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4128
Mailing Address - Country:US
Mailing Address - Phone:727-398-5295
Mailing Address - Fax:727-391-2742
Practice Address - Street 1:8211- 113 ST. NORTH
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4128
Practice Address - Country:US
Practice Address - Phone:727-398-5295
Practice Address - Fax:727-391-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62452Medicare ID - Type Unspecified
FLD57457Medicare UPIN