Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | G8505 | TX |
NPI | 1104867324 |
---|---|
Provider Name | John Aaron Whitfield |
First Address | Fort Worth, TX 76104-4124 |
Second Address | Fort Worth, TX 76104-4124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 06/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C23436 | (02) | TX |