# CHARLES D WHELAN III

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1922165026
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA10005113 | WA | Yes |

## Other

- **Enumeration date:** 01/02/2007
- **Last updated:** 11/18/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0111WH | REGENCE | WA |
| 01 | — | 0266104 | L&I AND CRIME VICTIMS | WA |
| 05 | — | 1922165026 | — | WA |