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Individual

DR. KENNETH A WHITTAKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
506 N VILLA RD, NEWBERG, OR 97132-1833
(503) 554-0036
(503) 538-9257
Mailing address
506 N VILLA RD, NEWBERG, OR 97132-1833
(503) 554-0036
(503) 538-9257

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD19011
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
081448
OR
Enumeration date
10/02/2006
Last updated
06/15/2021
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