Individual
DR. JOHN R WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2610 N WOODLAWN BLVD, WICHITA, KS 67220-2729
(316) 858-2610
(316) 858-2793
Mailing address
2610 N WOODLAWN BLVD, WICHITA, KS 67220-2729
(316) 858-2610
(316) 858-2793
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
05-20530
KS
207Q00000X
Family Medicine Physician
05-20530
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100229810I
—
KS
05
—
100229810J
—
KS
05
—
100229810Q
—
KS
05
—
100229810R
—
KS
01
—
P00615209
RR MEDICARE (PALMETTO)
KS
Enumeration date
07/18/2005
Last updated
12/17/2010
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