Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 16-1598 | AZ |
NPI | 1023550787 |
---|---|
Provider Name | Dr. Travis Whitney |
First Address | Phoenix, AZ 85018-5500 |
Second Address | Phoenix, AZ 85018-5500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2016 |
Last Update Date | 05/06/2020 |