Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 14210 | MS |
N | 204E00000X | Oral & Maxillofacial Surgeon | 263991 | MS |
NPI | 1497822662 |
---|---|
Provider Name | Dr. Scott Delano Whitaker |
First Address | Oxford, MS 38655 |
Second Address | Oxford, MS 38655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F96646 | (02) |