Individual
DR. JOHN C WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2713 S 74TH ST, SUITE 408, FORT SMITH, AR 72903-5170
(479) 484-5646
(479) 242-2323
Mailing address
2713 S 74TH ST, SUITE 408, FORT SMITH, AR 72903-5170
(479) 484-5646
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C-7165
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115671001
—
AR
Enumeration date
08/05/2006
Last updated
04/15/2011
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