Individual
DR. MICHAEL SHANE WHITLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
624 HOSPITAL DR. RAD. DEPT., MOUNTAIN HOME, AR 72653-2955
(870) 425-6322
(870) 424-5859
Mailing address
PO BOX 2008, MOUNTAIN HOME, AR 72654-2008
(870) 425-6322
(870) 424-5859
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E3746
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165369001
—
AR
Enumeration date
07/11/2006
Last updated
01/17/2017
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