Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TO3371 | MO |
NPI | 1003848615 |
---|---|
Provider Name | Dr. Patrick Glade Whitworth |
First Address | Independence, MO 64055-7030 |
Second Address | Independence, MO 64055-7030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 27/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U68919 | (02) | MO |