1750446878 NPI number — MR. GARY SCOTT WHITING PH.D.

Table of content: MR. GARY SCOTT WHITING PH.D. (NPI 1750446878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750446878 NPI number — MR. GARY SCOTT WHITING PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITING
Provider First Name:
GARY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1750446878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 OLD SAN ANTONIO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOERNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78006-3412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-331-1267
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8607 WURZBACH RD
Provider Second Line Business Practice Location Address:
SUITE V-104
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-697-3300
Provider Business Practice Location Address Fax Number:
210-424-0106
Provider Enumeration Date:
12/27/2006

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: 103TC1900X , with the licence number:  2-4700 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0343279-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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