Provider Demographics
NPI:1801908868
Name:CULLEY, WHELAN W III (MD)
Entity type:Individual
Prefix:
First Name:WHELAN
Middle Name:W
Last Name:CULLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 TEMPLE TER 300
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4869
Mailing Address - Country:US
Mailing Address - Phone:727-398-5295
Mailing Address - Fax:727-391-2742
Practice Address - Street 1:8211 113TH ST
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D57457Medicare UPIN
FL62452Medicare ID - Type Unspecified