Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6423 | KS |
N | 204E00000X | Oral & Maxillofacial Surgeon | 6423 | KS |
NPI | 1316968035 |
---|---|
Provider Name | Dr. William R Whitlow |
First Address | Hutchinson, KS 67502-1133 |
Second Address | Hutchinson, KS 67502-1133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 17/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022839 | BCBS WICHITA OFFICE (01) | KS |
022955 | BCBS HUTCHINSON OFFICE (01) | KS |
AW2825909 | DEA NUMBER (01) | KS |
T44090 | (02) | KS |