Organization
LAFAYETTE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS WAYNE WHETSELL M.D. (PRESIDENT)
(910) 323-1322
Entity
Organization
Contact information
Practice address
2125 VALLEYGATE DR, SUITE 201, FAYETTEVILLE, NC 28304-3753
(910) 323-1322
(910) 323-1510
Mailing address
PO BOX 43905, FAYETTEVILLE, NC 28309-3905
(910) 323-1322
(910) 323-1510
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
2080P0201X
Pediatric Allergy/Immunology Physician
—
—
2080P0214X
Pediatric Pulmonology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0138G
BLUE CROSS BLUE SHIELD
—
05
—
890138G
—
NC
01
—
CN6121
RAILROAD MEDICARE
—
Enumeration date
08/18/2006
Last updated
11/18/2008
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