Individual
WHIE OH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15250 LAKESHORE DR STE C, CLEARLAKE, CA 95422-8107
(707) 995-3764
(707) 995-0904
Mailing address
1001 ADAMS ST, STE 102, SAINT HELENA, CA 94574-1107
(707) 995-5628
(707) 995-0904
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
A24693
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A246930
—
CA
Enumeration date
08/03/2006
Last updated
02/09/2012
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