1669571659 NPI number — DAVID W WHATMORE P.A.

Table of content: DAVID W WHATMORE P.A. (NPI 1669571659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669571659 NPI number — DAVID W WHATMORE P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHATMORE
Provider First Name:
DAVID
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669571659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10103 RIDGEGATE PKWY
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124-5520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-225-8120
Provider Business Mailing Address Fax Number:
303-225-8130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10103 RIDGEGATE PKWY
Provider Second Line Business Practice Location Address:
#306
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-225-8120
Provider Business Practice Location Address Fax Number:
303-225-8130
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  841375754 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28782739 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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