Individual
KIM WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1620 E 12TH ST, THE DALLES, OR 97058
(541) 296-9151
Mailing address
PO BOX 1520, THE DALLES, OR 97058-8003
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD185852
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/03/2015
Last updated
07/24/2018
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