Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 167261 | NY |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 167261 | NY |
NPI | 1316944622 |
---|---|
Provider Name | M. Gordon Whitbeck JR. |
First Address | Rochester, NY 14617-5504 |
Second Address | Rochester, NY 14609-1738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 05/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01422691 | (05) | NY |
F34849 | (02) |