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Individual
DOUGLAS A. WHITEHEAD
Active
Individual
DOUGLAS A. WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
353
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000095313
BCBS PIN
MT
01
—
119700200
MDCD PIN
WY
01
—
4302311
MDCD PIN
MT
Enumeration date
09/13/2006
Last updated
05/19/2008
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