Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 16062 | OK |
NPI | 1043390164 |
---|---|
Provider Name | Dr. James Michael Whiteneck |
First Address | Fort Smith, AR 72903-4073 |
Second Address | Fort Smith, AR 72903-4073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 01/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100100530A | (05) | OK |
2673528 | MEDICARE (01) | AR |
5I280 | BLUE CROSS BLUE SHIELD (01) | AR |
B04697 | (02) | OK |