1821296724 NPI number — MR. STUART H WHITEMAN R.PH.

Table of content: MR. STUART H WHITEMAN R.PH. (NPI 1821296724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821296724 NPI number — MR. STUART H WHITEMAN R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITEMAN
Provider First Name:
STUART
Provider Middle Name:
H
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
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:
1821296724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13393 NW 11TH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-846-0622
Provider Business Mailing Address Fax Number:
954-944-1895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2955 W CORPORATE LAKES BLVD
Provider Second Line Business Practice Location Address:
STE 600
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33331-3663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-660-5555
Provider Business Practice Location Address Fax Number:
954-660-5566
Provider Enumeration Date:
07/03/2007

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: 1835G0303X , with the licence number:  14665 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1835G0303X , with the licence number: 36894 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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