Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC9335 | TX |
NPI | 1629126313 |
---|---|
Provider Name | Dr. Jesse P Whittaker |
First Address | Katy, TX 77450-3062 |
Second Address | Katy, TX 77450-3062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 19/12/2007 |